#130 - When your Clinical Documentation Ends up In Court: What Healthcare Providers Need to Know with Dr. Pankti Fadia, Part 3

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Welcome to The Factor podcast, where we talk about the
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stuff they didn't teach you in school, how to grow
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your practice, refine your clinical skills, and get better results
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for your patients. We're here to help you navigate the
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real world challenges of being a healthcare provider, from delivering
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top notch patient care to running a business that doesn't
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run you into the ground. Whether you're fresh out of
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school or scaling your practice, we're diving into effective, cutting
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edge treatments to get patients better, faster. We'll also talk
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about business strategies and tactics to help you work smarter
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and not harder, and the mindset shifts required to thrive
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as a top performer in your field so you can
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build a career you love without burning out. If you're
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ready to learn what works and what doesn't from leading experts,
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industry innovators, and respected clinicians across a wide range of specialties,
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you're in the right place, my friend. Let's dive in.
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Welcome back to the Factor podcast, where we bridge the
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gap between rehabilitation performance and real world clinical practice. I'm
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your host, Jessica Riddle, and today we're closing out our
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three part conversation with doctor Pankte Fidia on what healthcare
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providers need to understand when clinical care intersects with the
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legal system. In parts one and two, we talked about
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personal injury documentation. We talked about topics such as causations, subpoenas, depositions, testimony,
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and how providers can better prepare when their records or
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clinical decisions are questioned. In this final part of the series,
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the conversation will move into some of the areas that
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are often a little bit more complicated and frankly, more uncomfortable.
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Today discuss topics such as ethics, attorney driven care, reimbursement challenges,
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board complaints, co managing care with other providers, and how
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chiropractors can better advocate for the value of conservative care.
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Doctor Fidia also shares more about her own journey from
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chiropractor to law student, why she believes the chiropractic profession
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needs stronger research and legal advocacy, and why providers should
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take pride in their role, their training, and care they deliver.
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This episode is a strong reminder that credibility is not
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just about what's written in your notes. It's also about
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how you communicate, how you make clinical decisions, how you
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collaborate with other healthcare providers and how confidently you stand
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behind the value of your work. Let's dive into part
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three of my conversation with doctor Pinkti Fidia.
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In the next three minutes. Let's talk about ethics. No
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kickback referral scheme. Guys, it's illegal for attorneys to pay
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you for giving them cases or sending you cases.
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Same thing for you.
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You cannot be getting paid from MD offices for sending
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them cases or MRI companies. We know that it's always
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good to be reminded of that. Again, Please don't do it.
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Please don't have It's bad. You can lose your license
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and also get sued, so now you're going to incur
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attorney expenses of defense.
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It's not worth it.
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Please avoid attorney driven medical care documentation.
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Please please do not document that.
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I've seen so many chiropractic notes and it's just embarrassing,
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like why would you write that? But people do it,
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so don't do it. RICO is a new thing that
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chiropractors are facing.
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It's a.
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It's basically chiropractic are getting sued under the RICO Act.
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So make sure that you don't have any unethical conduct
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if not, the defense side insurance companies can book you
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under RICO and that's another three hour seminar for that
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webinars for that board complaints. A lot of these patients
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are complaining to the board because what happens is you
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release the patient and you expect the lawyer to give
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you money once their case gets settled, even with the reductions,
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but either attorneys don't pay you or there's something else
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going on. So a lot of these chiropractors are going
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to the patients and asking, hey, you saw treatment, pay
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me for my bill? Is that wrong to do? Absolutely not.
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You are legally allowed.
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To do it. Should you do it?
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Though?
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The answer is please don't do it, because this patient
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of yours, who were sent to your office by an attorney,
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it will not be very nice to you, and he
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will say, well, go talk to my attorney and have
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them pay you.
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I don't owe you anything.
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They don't understand how the system works, and if you
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go after them really strongly, then they'll file a board
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complaint and they'll make.
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Your life really, really difficult.
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So you, as a provider business owner, it's your decision
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on how you want to approach these cases. I personally
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I want peace of mind, so I don't go after
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my patients for non payment issues. It's just my personal
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business step. But again to each their own. And yeah,
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use models or visual aid. I don't know why it's
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in the ethics slide, but basically, like giving depositions, I
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always use models like this and I explain them discarnation,
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normal disc hernated disc things like that, so it helps
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to illustraight explain injuries, causation, things like that.
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That's it. Any questions, I have three minutes, Jessica, thank
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you so much.
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Yes, we do have a few questions we wanted to
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kind of dive into rather quickly. I appreciate again your
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time today and all of this great information. I know
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I certainly learned a lot and was taking some feverish
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notes over here. One of the questions I always like
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to start with, especially for instructors I have that are
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entering into a new career field, such as yourself. Everyone
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has their chiropractic story, right, Like so many times we
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hear of doctors telling us why they decided to choose
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the profession they're in. I'd love to learn a little
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bit more about what your attorney story is. So what
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inspired you, after already having your MBA, already having your
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doctorate in chiropractic, to go back to school to pursue
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your JD.
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Yeah, so I was actually a patient first. I got
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into a wreck. I didn't know what chiropractic was. And
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back then I used to do radio for fun, and
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so one of my mentors was a chiropractical attorney, was.
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The one that I used to interview and things like that.
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So I reached out to him many years ago after
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my accident and he inspired me to be a chiropractor first.
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And I had no intention of going to law school,
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but things happen and I got betrayed by I don't
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want to get into details, but yeah, it was a
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sad story and somebody defrauded me. And I said, you
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know what, I'm gonna take things into my own hand
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and I won't let this happen to me. So what
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can I do? And in that moment, I said, that's it.
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I'm going to be a lawyer and I will never
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let this happen to me again. So I applied to
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law school without thinking too much, and I said, if
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I get in, maybe it's destiny. And then I got in,
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and now I'm doing exactly what my mentor always did.
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He was a chiropractor first, then he became an attorney,
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and I'm kind of following that trajectory now.
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Myself absolutely well.
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I would say that your immense education is going to
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serve you well in practice as an attorney as well
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as educating other chiropractors as you are today. So another
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question that someone had reached out and written in about was,
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at at what point did you realize that the healthcare
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system and the legal system were kind of speaking two
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different languages? Like what has really kind of inspired you
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to go and do the research and publish the paper
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that you've published, and to continue pursuing these education opportunities
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to really advocate for chiropractic as a partner for the
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legal system, specifically when it comes to PI.
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I really want to say this, like, I feel chiropractice.
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Were not given the respect that other communities were given,
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and that always bothered me even when I was in school,
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and oftentimes like chiropractice in general, like we're not we
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don't sound very confident, and we're not really advocating for ourselves.
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And so when I started going to law school and
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started meeting a lot of attorneys, some of them didn't
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even know what chiropractic was, or they didn't quite understand
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and how we're different than pets, and so it was
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mostly like just me educating them. And I realized, how
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about I come up with a legal article, a lot
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review article that I can explain them what chiropractic is,
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how we can help them, how they can use our
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evidence and getting those verdicts that you see on social media.
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So how can we be helped to you?
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And so when I started doing that, I started writing
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a paper. Once you have something in written that can
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be used as evidence, So I'm trying to build evidence
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right now for future generations.
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So one day when in some random county.
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In Texas that there is a case out there and
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that attorney wants to say that this chiropractice is really
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good and this chiropractor helped my client and whatever he
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says is really good, how does he establish that? He'll
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pull up an article that I've written and other people
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have written and say, look, chiropractic credible for all the
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jury bias out there. So it starts at this level.
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We have to get the research out, not just what
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TCC is doing. With science research, but we also have
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to get research in the legal side.
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We also have to get.
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Research where we're saying that when we're billing somebody that
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it's not just it's valuable.
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Our profession can.
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Break that jury bias because we help patients, they get
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better and take us seriously. And so you have to
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come up with all that articles at the ground level.
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A lot of the times people ask me, what guidelines
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do we use in practice? Somebody made those guidelines long
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time ago that we're still using right an insurance company,
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we're paying a lot of these doctors to say that
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chiropractic care was not necessary beyond a certain point. That's
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why we're being hammered by this defensiveness right now that
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they're saying, oh, if you've treated them more than twenty
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times or whatever, I'm just throwing numbers out there that's excessive.
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Why because they'll pull out a guideline that's dated ninety
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back in ninety nineties, funded by the insurance company, to.
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Say that what we do is useless.
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So I'm saying, no, let's come up with more research
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and more legal articles to say across the globe, not
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just in Texas, but in the United States.
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This is what we do.
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Our patients are getting better and therefore you should bay
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us absolutely.
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And you know, I want to touch on something you
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said there that was very interesting to me. As soon
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as it's in written form, it can be utilized as evidence.
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So essentially the call to action for the healthcare community.
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But also it sounds like the legal community and those
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of yours soon to be colleagues who do handle personal
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injury and workers' compensation, where they would prefer to have
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conservative care as a means for their patients to get
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better faster. Is really to do the work, to do
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the research, to document well, but then also to put
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forth case studies and continue progressing and try to get
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published so that it can carry forward. It sounds like
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for future generations to be able to establish chiropractic as
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a go to.
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Means for that plasive tool.
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A plaintive attorney can bring my article in courtroom and say, look, judge,
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if I'm bringing this chiropractice expert, he's qualified. Many cases
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before you in this jurisdiction have accepted chiropractice similar to this,
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resume as an expert and whatever it is valuable. So
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this adds value from the legal side, where when defense
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is trying to say, we're not accepting this person's testimony,
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they're not even qualified as expert. No, they have been
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doing it for past twenty years in this jurisdiction. This
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is the number of cases that we've utilized this and
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have given large verdicts on this cases. Right, So that's
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where the legal documentation comes in. For science papers, my
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goal in the science journal is again, I'm not teaching
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doctors science. That's you guys. You guys are doing the
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actual research. I am just teaching doctors. Whatever science we
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have got right now, how about we articulate that and
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now win cases.
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For our side.
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And it can be anything not just personal injury, medical malpractice,
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or scope fighting for our scope.
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All the time.
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Right, you'll hear the Texas Chiropractic Association fighting all these cases.
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And so it's important that we have everything here, but
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we don't know how to communicate. So my job is
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to come here and do my best to educate chiropractice
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and say you have everything that you need. Let's just
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learn to communicate that to the other side, to legal
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professionals and medical doctors, and let's build credibility.
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Absolutely so I know you had mentioned that as a chiropractor,
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you have been the one that has been in that
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seat for depositions, you've testified before. What was that experience
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like for you the first time? And what are some
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just foundational pieces of advice that you would give, especially
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to students or those that are brand new in practice.
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What do you do when you get that call, and
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what are just some tips to help them have a
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great first experience.
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So I was very scared the first time I heard
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about it, and because I was also in like I
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switched that clinic, so I didn't have access to patient
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records and I got subpoenut so I had to be
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there and nobody was helping me. And so yeah, and
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there was no chat GPD back then that you can
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kind of google and they come up with like, oh,
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what to say on the fly. So that was just
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very very like not knowing the information was just I
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didn't even know what deposition was. And so then I
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asked around like other senior doctors who have done that,
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and so they explain me it's okay, They'll just ask
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you questions, basic stuff. Just answer what you can let
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them know that you don't have the record so that
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I was like I. People used to say, oh, it's
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hip hop, we.
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Can't release the records. Well no, it's not really true.
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In PI cases, when you see somebody the new records
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are going to be part of the official on records.
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You can get the records from either one of the
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lawyers and then prepare.
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So that was me navigating all of that.
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Now I exactly know what to do, So for younger
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cairos out there were listening to me and never being
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the posed before. First of all, understand it's such a
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normal bread and butter for attorneys to do it, so
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it's a regular day in their job, just like how
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you see a new patient. This is what they do
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for a living, right, so it's not a big deal.
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First of all, don't be anxious. Just get your documentation.
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If your employer can give it to you, great, If not,
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you can always get them from either one of the attorneys.
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If attorney their information is on the subpoena, or if
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they reach out to you by email, ask them I
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don't have any records, can you please give it to
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me Once you have your records?
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Read it three four, five six time, read it word
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to word.
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Understand what you wrote this maybe two three years ago, right, so,
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because that's how long the litigation process is. So by
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now you don't have any memory of this patient. So
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remember that, read your notes, and then go in and
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sound confident. You have to back up your own treatment.
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If you sound like, oh, I didn't think the MRI
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was necessary, then why did you order a doctor? So
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even if at this point in retrospect you're looking at
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your records and like what was I thinking, But don't
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do that in front of the don't do.
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That in deposition.
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Just act confident and say, yeah, I did that, and
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I stand by my record. The other person who's asking
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the questions, they are not a professor of chiropractic school,
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they are not doctors. Even they're lawyers. They don't know
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anything about chiropractic or law or.
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Medical And even if they do.
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You saw the patient, you thought it was medically necessary,
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you documented that, you ordered it. You stand behind your notes.
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So that's my best advice to everybody who's taking a
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deposition or trial testimony. You have to be confident, have
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to stand behind your treatment in your notes, even if
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you deep down you don't believe it. I'm sorry you're
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that person, you should have believed it to begin with,
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but right now you're gonna be like, nope, I am.
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I think this is the best treatment ever, and I'm
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the best doctor ever.
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And that's how you answer those questions.
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Now, confidence is key, especially when you're defending your own
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treatment plan, your own documentation of what you did for
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that patient, what have you found in your experience, and
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what have you seen. That is one of the most
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common documentation mistakes that chiropractors often make that may kill
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a case, it may really damage the case.
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So Red Flax, first of all, documenting attorney driven care,
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that's a problem. What happens in practice is that we
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generally seek we call these case managers and say do
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you approve this particular treatment right, which is wrong thing
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to do. Attorneys cannot approve medical treatment, but it's common
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industry practice. Now we're not saying do you approve a
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neck or BACKMRI. What we're saying is is that enough
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money in this case for the patient to go seek
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all this treatment? And so we can't document either one
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of these things in our documentation charts. It's just something
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that when you do it, you're saying that the lawyers
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are making all the decision instead of you making the
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medical decision. And in reality, the lawyers are not The
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00:18:26.319 --> 00:18:29.680
lawyers are not asking you to order this particular MRI
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or do this kind of treatment. You are making that
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decision as a chiropractor. But in industry practice, oftentimes our
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staff will contact them and say this is what we're recommending,
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and the lawyers will either say yes or no, depending
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on the finances of the case. And so my best
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advice to everybody who's listening right now is don't document
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that have those conversations on the phone, but definitely nowhere
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00:18:55.599 --> 00:18:59.000
on your record that it should reflect that attorney denied
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MRI or attorney approved MRI or attorney denied extension of treatment. No,
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you can never say that, and they should never be
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dictating you on how you should treat your patient.
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And I think the through line of everything that you
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said today and everything that you taught in today's webinar
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is that do what's right for your patient. Right just
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like the oath that you take when you become a
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chiropractor when you walk across that stage, Just like what
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you agree to in your jurisprudence exam when you're getting
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your license in your state. Your role as their healthcare
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provider is to put the patient's best interest first and
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to prioritize their health than what is needed. And from
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everything you've said, the main place where people really can
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mess up is if they forget that fact and they
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get more focused on the dollars and cents or possibly
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even the legal process involved, instead of truly saying, Okay,
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this is this individual patient needs individual care. They're not
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going to need as you mentioned earlier, they're not going
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to need cookie cutter care. And every single patient that
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comes in that has a whiplash injury needs to get
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exactly the same thing. Because everyone's different, everyone may respond differently,
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So I think that's really kind of an important thing
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to mention there. Another question that came in, someone was
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asking just.
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To ask the redflex. The other thing that I see
367
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a lot is it's not necessarily a reflex, but you're
368
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not really putting causation there. So causation is the element
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that you're going to get hammered a lot by the
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defense attorney. So always make sure that you were saying
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those injuries are because of the car accident, Like there's.
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One line here somewhere connecting that all your.
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Orthopedic findings, all of that says more likely than not
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this is from the car accident, so that you should
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definitely document. And please don't throw your client under the bus.
376
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This is what the plane if attorney say.
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So.
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00:21:01.079 --> 00:21:02.799
I was just having a conversation with one of the
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00:21:02.920 --> 00:21:04.759
tourney friends of mine and he said a lot of
380
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the time these chidropractors are saying things like the patient
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is not exorcising.
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They're documenting these things.
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Patient refuse to exercise, patient is not consistently coming in.
384
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We're doing this.
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00:21:16.799 --> 00:21:19.400
I guess I don't know why a chiropractor would say that.
386
00:21:19.440 --> 00:21:22.680
Maybe they're trying to justify the gap, or they're saying, hey,
387
00:21:22.759 --> 00:21:25.279
like cuhya, like I'm telling you to do these things,
388
00:21:25.319 --> 00:21:28.519
but you're not doing it. These are the conversations best
389
00:21:28.559 --> 00:21:31.720
to have done on the phone or face to face
390
00:21:31.759 --> 00:21:35.079
with the client or with the patient. Please don't document
391
00:21:35.119 --> 00:21:37.960
that like you're making a look really bad on purpose.
392
00:21:38.599 --> 00:21:41.720
You want way to say, patient's just not compliant. I
393
00:21:41.720 --> 00:21:44.640
think that's okay to say, don't go into details as
394
00:21:44.680 --> 00:21:50.279
to what they're doing wrong. So documenting the negatives, I
395
00:21:50.319 --> 00:21:53.359
don't document it unless you absolutely have to try to
396
00:21:53.400 --> 00:21:57.079
be thoughtful about what you're writing, because every single thing
397
00:21:57.119 --> 00:22:01.240
that you write is going to be used against you
398
00:22:01.599 --> 00:22:03.599
or for you in coord by boat.
399
00:22:03.680 --> 00:22:04.759
Yeah.
400
00:22:04.839 --> 00:22:07.920
No, absolutely, And I think you're right. There is a
401
00:22:08.039 --> 00:22:11.640
very salient way to still document in a compliant manner,
402
00:22:11.680 --> 00:22:15.880
to say the patient's being in compliant without, as you mentioned,
403
00:22:15.920 --> 00:22:17.839
kind of airing all the dirty laundry and throwing them
404
00:22:17.880 --> 00:22:20.119
under the bus and saying, well, they did yard work
405
00:22:20.119 --> 00:22:23.079
this weekend when I told them not to, or they
406
00:22:23.440 --> 00:22:26.519
aren't doing their exercises on these specific days or whatnot.
407
00:22:27.519 --> 00:22:31.759
Someone else was asking a question here about the first
408
00:22:31.839 --> 00:22:36.000
thing that a defense attorney usually looks for when they
409
00:22:36.079 --> 00:22:39.480
get the notes. When they get the documentation from a chiropractor,
410
00:22:39.880 --> 00:22:42.759
are they going through with a big yellow highlighter? And
411
00:22:42.839 --> 00:22:46.319
if they see these specific things, they're like, oh, yeah,
412
00:22:46.480 --> 00:22:48.519
I've got this dog.
413
00:22:49.519 --> 00:22:54.240
So long before AI happened, I think insurance companies had softwares,
414
00:22:54.319 --> 00:22:56.920
So your notes are not being read by a human.
415
00:22:57.440 --> 00:23:00.000
It was going through a software even before the whole
416
00:23:00.160 --> 00:23:03.200
AI stuff. I'm sure even right now, it goes through
417
00:23:04.200 --> 00:23:07.079
a software. Whill will spit out a number like how
418
00:23:07.119 --> 00:23:10.680
much is the case worth? And they go through your
419
00:23:10.759 --> 00:23:14.400
diagnosis and some key language in there, and it's also
420
00:23:14.519 --> 00:23:20.640
designed to red flags some of the inconsistencies, so your
421
00:23:20.799 --> 00:23:24.359
notes in reality are not being read by defense attorney.
422
00:23:24.359 --> 00:23:27.319
Defense attorneys don't even come into play in the beginning.
423
00:23:27.440 --> 00:23:30.960
It's only your lawyer, I mean, your patient's lawyer, and
424
00:23:31.000 --> 00:23:32.359
an insurance adjuster on.
425
00:23:32.319 --> 00:23:33.039
The other side.
426
00:23:33.359 --> 00:23:37.319
An insurance adjuster's job is they think that this money
427
00:23:37.480 --> 00:23:40.039
is their own money, and if they give you one
428
00:23:40.079 --> 00:23:41.240
dollar of their own money.
429
00:23:41.039 --> 00:23:43.480
That they're going to die tomorrow. So they will not
430
00:23:44.400 --> 00:23:48.759
minimal expenditure. So so they will find the same thing.
431
00:23:48.799 --> 00:23:52.440
They'll say treatment was not medically necessary, it's too excessive.
432
00:23:53.039 --> 00:23:53.680
You wouldn't have.
433
00:23:53.720 --> 00:23:56.880
Ordered an MRI if this was a health insurance case.
434
00:23:57.400 --> 00:24:00.359
So they'll say the same thing irrespective of whatever is
435
00:24:00.400 --> 00:24:04.200
going on. But then defense attorneys will generally come into
436
00:24:04.240 --> 00:24:08.200
play if it's a commercial case, so it's a really
437
00:24:08.359 --> 00:24:11.480
big policy case. That's why insurance people will hire defense
438
00:24:11.480 --> 00:24:15.720
attorneys because it makes at this point the stakes are
439
00:24:15.759 --> 00:24:19.880
so high that they're okay spending money on defense because
440
00:24:19.920 --> 00:24:23.799
defense attorneys they don't get paid like for plaintiff side,
441
00:24:23.839 --> 00:24:25.720
you get paid if you win the case. If there
442
00:24:25.720 --> 00:24:28.720
are settlement, you get paid for defense. The insurance company
443
00:24:28.759 --> 00:24:31.720
will pay them per hour. Oh yeah, they are pretty
444
00:24:31.759 --> 00:24:34.200
expensive for the insurance side, so they won't get a
445
00:24:34.240 --> 00:24:34.920
defense attorney.
446
00:24:35.000 --> 00:24:37.559
So your case is not being looked by a defense attorney.
447
00:24:37.839 --> 00:24:40.920
Now, when they do look at it, their paralegal have
448
00:24:41.160 --> 00:24:46.319
gone through every single note, every single word, and they
449
00:24:46.319 --> 00:24:49.200
will look for inconsistency. So if the pains, if the
450
00:24:49.240 --> 00:24:51.359
pain level was really high one day and it's super
451
00:24:51.400 --> 00:24:54.079
down the next day and then again high, So if
452
00:24:54.119 --> 00:24:56.559
it's really the case, then you have to explain why.
453
00:24:56.599 --> 00:24:59.000
So like you mentioned the yard work, right, I would
454
00:24:59.000 --> 00:25:01.960
document that ohation did yard work and that.
455
00:25:01.880 --> 00:25:04.519
Flared up their symptoms. And it's a good thing because
456
00:25:04.519 --> 00:25:07.519
they were doing yardwork before the car accident. They started
457
00:25:07.480 --> 00:25:09.759
to get again and now they're not able to win.
458
00:25:09.799 --> 00:25:12.839
It causes them a lot of pain and exacerbates their symptoms.
459
00:25:13.000 --> 00:25:15.279
And so those are the things. If there is inconsistent
460
00:25:15.319 --> 00:25:19.160
inconsistency in your findings, explain it. If your treatment is
461
00:25:19.200 --> 00:25:21.640
going really good most of the time, it's like a
462
00:25:21.640 --> 00:25:23.799
lot of pain, a lot of pain getting better and
463
00:25:25.359 --> 00:25:27.680
it's better, better, better, and they're still treating them. The
464
00:25:27.720 --> 00:25:31.359
patient in another ten to fifteen sessions. Why if it
465
00:25:31.480 --> 00:25:33.839
was that good, why did you not release them? If
466
00:25:33.880 --> 00:25:36.319
it was that bad, why did you not send them out?
467
00:25:36.400 --> 00:25:39.279
Because clearly chiropractic care is not working. So it's this
468
00:25:39.920 --> 00:25:44.079
sweet spot in there somewhere you have to explain why you.
469
00:25:44.000 --> 00:25:44.960
Are still treating them.
470
00:25:45.039 --> 00:25:48.279
Also, if they are in so much pain, are you
471
00:25:48.759 --> 00:25:52.079
sending them somewhere else? Because your treatment is reaching mme?
472
00:25:52.920 --> 00:25:57.240
And so these are the things that a good chiropracter will.
473
00:25:57.079 --> 00:26:00.640
Try to explain in chartings best says they can.
474
00:26:01.440 --> 00:26:04.480
And then, like I said, your job is not to
475
00:26:04.519 --> 00:26:07.880
defend the patients, so you do your best to defend
476
00:26:07.920 --> 00:26:08.440
your notes.
477
00:26:08.640 --> 00:26:11.279
If you have bad facts, you have bad facts.
478
00:26:11.319 --> 00:26:14.359
That's up to the attorneys that swing it and say, yes,
479
00:26:14.400 --> 00:26:17.240
I understand doctor, you said that the patient had gaps
480
00:26:17.240 --> 00:26:20.880
and treatment, But when they came back, what did they do?
481
00:26:20.960 --> 00:26:21.880
What are they exercising?
482
00:26:21.920 --> 00:26:22.400
What happened?
483
00:26:22.400 --> 00:26:25.839
So then the attorneys will use your testimony in whichever
484
00:26:25.880 --> 00:26:28.920
way they want to guide you there. But I wouldn't
485
00:26:28.960 --> 00:26:31.519
go out of my way as a provider to be
486
00:26:31.599 --> 00:26:32.880
an advocate for them.
487
00:26:32.920 --> 00:26:36.200
Personally, I'll try to see as best as I can.
488
00:26:37.119 --> 00:26:39.559
Absolutely, and I think one thing that you said was
489
00:26:39.640 --> 00:26:43.920
key there. It is so important to do a great
490
00:26:44.720 --> 00:26:49.839
exam history and kind of an initial assessment to get
491
00:26:49.880 --> 00:26:53.160
that starting point you mentioned earlier, even os Westry questionnaires
492
00:26:53.319 --> 00:26:55.799
or yellow Flag questionnaires like go ahead and get a
493
00:26:55.839 --> 00:26:58.519
baseline and do a really thorough job in the beginning
494
00:26:59.279 --> 00:27:02.559
so that you know your starting point and then continue
495
00:27:02.559 --> 00:27:04.680
to reassess along the way, which is something that I
496
00:27:04.720 --> 00:27:07.279
know we teach in our factor courses. That's something that
497
00:27:07.400 --> 00:27:11.759
so many evidence based systems advocate for is you have
498
00:27:11.839 --> 00:27:14.160
to continue to assess along the way to see how
499
00:27:14.200 --> 00:27:18.200
they're progressing in their care and then be prepared to
500
00:27:18.279 --> 00:27:23.480
pivot and make a change or refer out if necessary. Now,
501
00:27:23.079 --> 00:27:28.680
how sticky of a situation does that become? When the
502
00:27:28.759 --> 00:27:32.799
chiropractor does the initial assessment intake, they treat a patient
503
00:27:32.839 --> 00:27:35.920
for a period of time, they're not getting the level
504
00:27:35.960 --> 00:27:38.640
of improvement that they expected, and then they have to
505
00:27:38.680 --> 00:27:44.440
refer out to another provider co managing care for patients
506
00:27:45.400 --> 00:27:49.160
inside of a case like this. Does that become very
507
00:27:49.200 --> 00:27:52.759
cumbersome the on behalf of the chiropractor. Does that become
508
00:27:52.759 --> 00:27:55.480
a headache for the attorney when you have multiple healthcare
509
00:27:55.559 --> 00:27:59.240
providers that you're trying to make sure all can still
510
00:27:59.720 --> 00:28:02.000
get reimbursed for the care that they do provide for
511
00:28:02.039 --> 00:28:02.599
this patient.
512
00:28:04.039 --> 00:28:05.119
So very good question.
513
00:28:05.519 --> 00:28:09.440
When you are working the personal injury world, it's not
514
00:28:09.799 --> 00:28:12.680
me versus the other provider. We're all on one side
515
00:28:12.799 --> 00:28:16.839
or we're towards the patient side. So reimbursement, I'll talk
516
00:28:16.839 --> 00:28:19.640
about it later, but first, when it comes to co management,
517
00:28:20.480 --> 00:28:24.079
every single PI case will be co managed because if
518
00:28:24.119 --> 00:28:26.119
it's a car accident case, a lot of the times
519
00:28:26.119 --> 00:28:28.599
they've gone to er, they've already seen a medical doctor,
520
00:28:28.680 --> 00:28:31.079
or they may have gone to an urgent care, or
521
00:28:31.240 --> 00:28:33.880
the lawyers may send them to these places for them
522
00:28:33.880 --> 00:28:37.799
to get their initial medicine. Once you get the MRIs done,
523
00:28:37.839 --> 00:28:40.400
if they need it, if THEMRIS medically necessary. A lot
524
00:28:40.400 --> 00:28:43.880
of the times these patients come back with her neated discs,
525
00:28:44.160 --> 00:28:49.640
some kind of traumatic injuries that require at least a
526
00:28:49.680 --> 00:28:52.680
second opinion, in my personal opinion, for you to have
527
00:28:52.799 --> 00:28:55.160
them send to a medical doctor, because at the end
528
00:28:55.200 --> 00:28:57.519
of the day, these are I think a car accident.
529
00:28:57.839 --> 00:29:01.039
This carnation is a permanent damage goes back to zero,
530
00:29:01.400 --> 00:29:04.039
her needed disc will maybe go down a little bit,
531
00:29:04.079 --> 00:29:05.880
but will never be what it used to. Be before
532
00:29:05.920 --> 00:29:08.839
the car accident, so it's always important for them to
533
00:29:08.960 --> 00:29:13.440
have the best possible treatment. We as chiropractice, we do rehab,
534
00:29:13.519 --> 00:29:18.480
physical therapy modalities. We help them with this structural aspect.
535
00:29:18.519 --> 00:29:20.519
But then there's also a need for them to see
536
00:29:20.519 --> 00:29:22.920
other providers, especially MD, so that.
537
00:29:23.000 --> 00:29:23.960
They have their options.
538
00:29:24.039 --> 00:29:26.960
What if they want to do other interventions, what if
539
00:29:27.000 --> 00:29:31.200
they want a dissectomy, or what if they want initial
540
00:29:31.240 --> 00:29:34.480
pain medicine, things like that. It's you should give them
541
00:29:34.519 --> 00:29:37.960
all the options. And so it's not ME versus MD,
542
00:29:38.319 --> 00:29:38.920
and who's going.
543
00:29:38.920 --> 00:29:40.559
To see the patient more. It's always me.
544
00:29:40.839 --> 00:29:46.839
MDPT, orthopedic doctor, neurologists. We're all one team. We're all
545
00:29:46.839 --> 00:29:49.519
going to do what we can do for these patients.
546
00:29:49.559 --> 00:29:52.079
So I focus on what I can do within my scope.
547
00:29:52.720 --> 00:29:57.200
Neurologists will evaluate them. If the patient doesn't need surgery,
548
00:29:57.400 --> 00:30:00.880
no other intervention, they'll release them, say yeah, you're doing good, chiropractor,
549
00:30:01.000 --> 00:30:04.359
keep doing this. So that's how it works in our lineup.
550
00:30:04.359 --> 00:30:06.720
In the PI work, you're always going to work with
551
00:30:06.799 --> 00:30:11.640
other doctors. Now let's talk about reimbursement. Now that's where
552
00:30:12.119 --> 00:30:17.200
it gets murky, because the more providers this particular patient
553
00:30:17.279 --> 00:30:19.599
is going to see. Everybody is going to have their
554
00:30:19.640 --> 00:30:22.480
own bill, and the insurance is.
555
00:30:22.440 --> 00:30:24.799
Handing out money.
556
00:30:24.880 --> 00:30:29.480
Somebody is going to get really bad reduction, and it's
557
00:30:29.519 --> 00:30:32.559
most of the time it's us, And it's really sad.
558
00:30:33.000 --> 00:30:37.039
As chiropractors, we see them for so many more visits
559
00:30:37.119 --> 00:30:39.680
than what an would. MD will see them maybe twice,
560
00:30:40.119 --> 00:30:43.119
we'll see them and number of visits and towards the
561
00:30:43.200 --> 00:30:46.839
end and MD will probably get paid more than what
562
00:30:46.920 --> 00:30:49.319
I will. And it's sad.
563
00:30:49.400 --> 00:30:51.839
But again that's the nature of the industry.
564
00:30:51.920 --> 00:30:55.000
But a lot of the times chiropractors will then say, well,
565
00:30:55.039 --> 00:30:57.920
in that case, how about I not send this patience
566
00:30:57.960 --> 00:31:01.240
to other providers and I keep the whole check to myself.
567
00:31:01.920 --> 00:31:05.599
Really really bad business decision, also really bad for your patient.
568
00:31:05.640 --> 00:31:09.279
Also bad from the defense perspective. Why, Because you will
569
00:31:09.319 --> 00:31:10.119
get that question.
570
00:31:10.279 --> 00:31:13.920
It's counterintuitive, right, we are always expecting that question, Oh, doctor,
571
00:31:13.920 --> 00:31:15.400
did you send out for this MRI?
572
00:31:15.680 --> 00:31:15.880
Yes?
573
00:31:15.920 --> 00:31:19.000
I did, was it medically necessary? You will also get
574
00:31:19.039 --> 00:31:21.480
the question, well, why did you not send out for MRI?
575
00:31:21.799 --> 00:31:23.960
If your patient was hurting for four weeks? Why did
576
00:31:24.000 --> 00:31:28.400
you not If them came back positive for discarnation, why did.
577
00:31:28.240 --> 00:31:29.920
You not send them to a medical doctor.
578
00:31:30.000 --> 00:31:32.119
And if you say, well, I don't think that was necessary,
579
00:31:32.720 --> 00:31:34.920
you Hong Kong believe they're going to have a whole
580
00:31:34.960 --> 00:31:38.680
list of other chiropractice testimony from god knows everywhere and say,
581
00:31:38.720 --> 00:31:41.720
if you have a herniated disk, the standard practice, a
582
00:31:41.759 --> 00:31:43.839
standard of care is for them to see an MD.
583
00:31:44.359 --> 00:31:48.079
You fail to do that, you are followed calling below
584
00:31:48.119 --> 00:31:51.400
the standard. So it's like a double ed sword, like
585
00:31:51.480 --> 00:31:54.680
if I do it, I still get in questioning from
586
00:31:54.720 --> 00:31:56.880
the defense side. If I don't do it, the defense
587
00:31:56.880 --> 00:32:01.960
will attack that. So you don't think too much. See
588
00:32:01.960 --> 00:32:06.119
your patients, do your best, and when it comes to compensation,
589
00:32:07.039 --> 00:32:11.400
have a spine. Just know that you're going to get compensated.
590
00:32:11.440 --> 00:32:13.720
If the attorneys are not paying you, don't work with them.
591
00:32:14.240 --> 00:32:17.119
But don't go after your patients for the rest of
592
00:32:17.160 --> 00:32:20.039
the bill because they'll BUYE two like, they'll file board
593
00:32:20.079 --> 00:32:22.400
complaints and do everything in their power to make.
594
00:32:22.279 --> 00:32:22.799
You look bad.
595
00:32:22.839 --> 00:32:26.920
It's bad pr more stress, So write it off and
596
00:32:27.240 --> 00:32:30.200
maybe sign up for factors and you can start having
597
00:32:30.240 --> 00:32:34.359
a different stream of revenue coming in from cash patients
598
00:32:34.400 --> 00:32:35.640
and health insurance patients.
599
00:32:35.720 --> 00:32:39.400
Right, yeah, absolutely, And that's a good point too, as
600
00:32:39.400 --> 00:32:42.640
a patient. You've already been through a traumatic accident of
601
00:32:42.680 --> 00:32:46.920
some sort, you've already encountered pain, and to have to
602
00:32:47.000 --> 00:32:51.400
also navigate the legal process and all of the different providers.
603
00:32:51.440 --> 00:32:54.720
The last thing that you want after everything finally gets
604
00:32:54.720 --> 00:32:58.319
settled is to get a phone call with someone saying, Hey,
605
00:32:58.480 --> 00:33:01.039
I really need you to pay this bill, because even
606
00:33:01.079 --> 00:33:03.480
though you thought it was going to be covered, it wasn't.
607
00:33:03.599 --> 00:33:07.559
So I think that's an important takeaway for sure. I
608
00:33:07.599 --> 00:33:09.880
have one last question that I wanted to kind of
609
00:33:09.960 --> 00:33:13.400
ask and leave us with today for today's discussion. Again,
610
00:33:13.720 --> 00:33:16.160
I appreciate you so much coming on and teaching about
611
00:33:16.160 --> 00:33:19.960
this because it's so important and I think there is
612
00:33:20.039 --> 00:33:23.279
a great deal of opportunity for doctors out there that
613
00:33:23.440 --> 00:33:27.920
are looking to work with attorneys in this manner and
614
00:33:28.480 --> 00:33:31.960
to help patients that are dealing with these type of
615
00:33:32.039 --> 00:33:36.640
injuries or situations. What is the one question that no
616
00:33:36.680 --> 00:33:40.319
one ever really asks you, but you are secretly hoping
617
00:33:40.359 --> 00:33:44.640
that someone would in regards to all of this. I
618
00:33:44.680 --> 00:33:49.799
know that oftentimes you may get questions about specific cases
619
00:33:49.920 --> 00:33:53.079
or things that you can't necessarily speak to, But is
620
00:33:53.079 --> 00:33:56.279
there something that's kind of a burning topic or just
621
00:33:56.440 --> 00:33:59.880
a statement that you wanted to leave either existing help
622
00:34:00.079 --> 00:34:02.880
care providers with or even the next generation of either
623
00:34:03.000 --> 00:34:06.279
providers or attorneys coming up, that you'd want to leave
624
00:34:06.279 --> 00:34:08.639
our audience with today, just to kind of ponder and
625
00:34:08.679 --> 00:34:11.000
think on, Oh.
626
00:34:10.760 --> 00:34:14.159
This is a tough question. I mean, they generally ask
627
00:34:14.280 --> 00:34:17.679
me like from everything from technical to what law is
628
00:34:17.800 --> 00:34:20.960
and where I stand. I just want to tell my
629
00:34:21.039 --> 00:34:24.719
fellow chiropractors who are listening right now, I love being
630
00:34:24.760 --> 00:34:27.960
a chiropractor. I'm so passionate about this profession.
631
00:34:27.960 --> 00:34:28.880
Even if I'm.
632
00:34:28.760 --> 00:34:31.320
Going to be an attorney, I'll always be a chiropractor first.
633
00:34:31.639 --> 00:34:34.119
I think that's my identity now and I take pride
634
00:34:34.159 --> 00:34:37.159
in what I do, and that means I will also
635
00:34:37.280 --> 00:34:41.360
charge for my time. I like chiropractors when they are
636
00:34:41.719 --> 00:34:46.159
giving testimony or depositions or even on the other side.
637
00:34:46.159 --> 00:34:51.480
Sometimes defense will hire chiropractors to give expert testimony. We're
638
00:34:51.480 --> 00:34:56.360
not charging them enough. We feel like we're undervalued and
639
00:34:56.559 --> 00:35:00.679
that shows. So please be proud of your profession. Just
640
00:35:00.840 --> 00:35:05.039
know that you're an incredible doctor. Why Because you're healing
641
00:35:05.079 --> 00:35:09.000
these people without giving them opioids. Your patients will love you.
642
00:35:09.480 --> 00:35:12.519
Whatever treatment that you're doing. You're not doing anything wrong.
643
00:35:12.679 --> 00:35:15.559
Even if they say you're doing excessive treatment, that's insurance
644
00:35:15.599 --> 00:35:18.239
company trying to play with your head. Don't believe them.
645
00:35:18.639 --> 00:35:21.800
You're not injecting them with medicine, You're not doing any
646
00:35:21.840 --> 00:35:26.239
surgeries on them. You are training them how to take
647
00:35:26.280 --> 00:35:30.079
care of their bodies. You're teaching them posture exercises, any
648
00:35:30.159 --> 00:35:33.199
kind of rehab. Even after they're done with you, whatever
649
00:35:33.280 --> 00:35:35.440
you taught them that will.
650
00:35:35.360 --> 00:35:36.079
Stay with them.
651
00:35:36.559 --> 00:35:40.239
So so take pride in your profession. And when the
652
00:35:40.360 --> 00:35:44.400
legal community approaches you and they ask for your help,
653
00:35:45.079 --> 00:35:49.960
don't do it for free. It's okay to ask for money.
654
00:35:50.239 --> 00:35:53.199
And if they don't pay you for your cases, there
655
00:35:53.199 --> 00:35:55.039
are things that you can do which I'm not going
656
00:35:55.079 --> 00:35:58.039
to go into details for, but like, don't your patient
657
00:35:58.079 --> 00:36:01.760
does not your problem. Don't go after the patient. You
658
00:36:01.800 --> 00:36:04.960
can still go after the attorneys. But there's a right
659
00:36:04.960 --> 00:36:07.840
way and wrong way to do it. So just just
660
00:36:08.039 --> 00:36:11.519
love what you do and have faith in yourself and
661
00:36:11.519 --> 00:36:15.559
in your profession, and be aggressive out there. Don't come
662
00:36:15.599 --> 00:36:20.559
off as oh, I'm just I'm just a chiropractor. No no, no,
663
00:36:20.599 --> 00:36:24.000
I'm a doctor of chiropractic. I have all the credentials
664
00:36:24.440 --> 00:36:26.960
and I'm doing good work every day and therefore I
665
00:36:27.039 --> 00:36:28.639
earn my place in this industry.
666
00:36:29.480 --> 00:36:31.960
Oh, I love it. That's a great message, definitely a
667
00:36:32.000 --> 00:36:35.360
great one to wrap up today. Well, congratulations on your
668
00:36:35.840 --> 00:36:39.800
journey through this new facet of your education, and congratulations
669
00:36:39.840 --> 00:36:42.800
on your upcoming graduation next month. We look forward to
670
00:36:42.800 --> 00:36:44.880
hearing much more from you in the future and some
671
00:36:44.920 --> 00:36:49.440
additional courses and trainings to help educate your fellow healthcare providers.
672
00:36:49.880 --> 00:36:52.079
And we thank you again for today. We really appreciate
673
00:36:52.079 --> 00:36:52.519
you coming on.
674
00:36:53.000 --> 00:36:56.360
Thank you Jessica, and shout out to doctor Riddle. I
675
00:36:56.440 --> 00:36:59.079
still use every single we have.
676
00:36:59.079 --> 00:37:00.480
Exercise the me.
677
00:37:02.000 --> 00:37:04.239
And so both of you are amazing people and you're
678
00:37:04.239 --> 00:37:06.960
doing a lot for our chiropractic community. So I really
679
00:37:06.960 --> 00:37:16.239
really appreciate that, and thank you for this platform.
680
00:37:19.360 --> 00:37:22.920
That wraps up our three part conversation with doctor Paninkte Fidia.
681
00:37:23.639 --> 00:37:27.119
Throughout the series, doctor Fidias helped us better understand the
682
00:37:27.159 --> 00:37:33.719
intersection of chiropractic care, personal injury, documentation, legal proceedings, testimony, ethics,
683
00:37:34.079 --> 00:37:38.840
and professional credibility, and in this final episode, she left
684
00:37:38.920 --> 00:37:43.679
us with an important reminder chiropractors and other healthcare providers
685
00:37:44.000 --> 00:37:48.280
should not minimize the value they provide. When you're helping
686
00:37:48.320 --> 00:37:52.360
patients recover, teaching them how to move better, documenting their progress,
687
00:37:52.800 --> 00:37:57.039
referring when appropriate, and staying focused on ethical, patient centered care,
688
00:37:57.519 --> 00:38:00.800
the work that you do matters, and when care becomes
689
00:38:00.840 --> 00:38:03.960
part of legal process, providers need to be prepared to
690
00:38:04.000 --> 00:38:08.519
communicate clearly, stay within their scope, and stand confidently behind
691
00:38:08.559 --> 00:38:12.639
clinical decisions. One of the biggest themes from this series
692
00:38:12.719 --> 00:38:17.079
is that good documentation starts long before anyone requests your records.
693
00:38:17.719 --> 00:38:20.920
It starts with a thorough history, a strong exam, clear
694
00:38:21.000 --> 00:38:26.960
clinical reasoning, appropriate reassessment, and thoughtful communication across the continuum
695
00:38:27.000 --> 00:38:31.000
of care. A huge thank you to doctor Panktifidia for
696
00:38:31.039 --> 00:38:34.559
sharing such a unique and valuable perspective. As both a
697
00:38:34.639 --> 00:38:38.400
practicing chiropractor and soon to be attorney, her work is
698
00:38:38.440 --> 00:38:41.400
helping to bridge an important gap between healthcare and law,
699
00:38:41.679 --> 00:38:44.360
and I know this conversation will be valuable for a
700
00:38:44.360 --> 00:38:50.360
provider's navigating personal injury care, documentation, depositions, and everything that
701
00:38:50.400 --> 00:38:54.679
goes along with the medico legal questions in practice. As always,
702
00:38:54.760 --> 00:38:57.800
thanks for listening to the Factor podcast. If this series
703
00:38:57.840 --> 00:38:59.719
was helpful, be sure to share it with a colleague,
704
00:38:59.760 --> 00:39:02.800
subscribe to the show and sign up to attend one
705
00:39:02.840 --> 00:39:05.519
of our hands on core dates. You can visit the
706
00:39:05.599 --> 00:39:07.960
link in our show notes that'll take you directly to
707
00:39:08.039 --> 00:39:13.400
factor education dot com. That's fak tr education dot com,
708
00:39:13.440 --> 00:39:16.079
where you can learn more about all of the different
709
00:39:16.519 --> 00:39:19.679
offerings that we have, from hands on trainings to online
710
00:39:19.719 --> 00:39:22.960
courses and certifications, as well as a number of different
711
00:39:23.039 --> 00:39:30.360
free resources as well. If there are other topics, trainings,
712
00:39:30.519 --> 00:39:33.039
or even guests that you'd like us to have on
713
00:39:33.119 --> 00:39:35.679
the show, please be sure to head to our website.
714
00:39:35.760 --> 00:39:38.440
It's also linked in the show notes at factor podcast
715
00:39:38.559 --> 00:39:43.199
dot com. That's faktr podcast dot com, and we'd love.
716
00:39:43.079 --> 00:39:43.639
To hear from you.
717
00:39:43.679 --> 00:39:47.320
We're always interested in learning more about different instructors that
718
00:39:47.400 --> 00:39:50.599
could bring value to our audience and are not shy
719
00:39:50.679 --> 00:39:53.559
about tackling any new topics that you might want to
720
00:39:53.599 --> 00:39:56.360
have us cover or feature so that we can continue
721
00:39:56.400 --> 00:39:58.440
to add value to those of you that are listening
722
00:39:58.440 --> 00:40:02.320
from around the globe. Our next episode drops in two weeks,
723
00:40:02.400 --> 00:40:04.519
so be sure to tune in there. We'll be talking
724
00:40:04.599 --> 00:40:09.039
about the mental aspects of performance and some of the
725
00:40:09.599 --> 00:40:13.840
important things that healthcare providers should consider when working with
726
00:40:14.559 --> 00:40:18.719
athletes or even just high performers. In general, people that
727
00:40:18.760 --> 00:40:22.320
are CEOs, extremely driven, people who are trying to improve
728
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their life in some way and different ways that you
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00:40:25.119 --> 00:40:29.440
can spot some of the mental health aspects, some of
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00:40:29.440 --> 00:40:33.840
the emotional or the psychological aspects that might be contributing
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to how that patient is or is not progressing according
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00:40:37.400 --> 00:40:39.800
to your care plan. Be sure to tune in every
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00:40:39.840 --> 00:40:42.800
two weeks on Friday where we drop new episodes and
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we'll see you next time. Hey guys, if you like
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00:40:47.039 --> 00:40:49.119
what you heard today, I encourage you to visit our
736
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website at Factor hyphenstore dot com that's spelled fak tr
737
00:40:55.679 --> 00:40:59.480
hyphenstore dot com to find out more information about all
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00:40:59.519 --> 00:41:01.480
that we have to offer. We have a variety of
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00:41:01.519 --> 00:41:04.519
online offerings as well as our hands on Factor Rehab
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00:41:04.559 --> 00:41:07.519
System course scheduled in cities around the globe. Be sure
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00:41:07.519 --> 00:41:10.239
to also check out our event calendar and bookmark any
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00:41:10.280 --> 00:41:13.159
of these upcoming live webinar dates coming up in the.
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00:41:13.119 --> 00:41:14.880
Near future so you can join us live.
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00:41:15.000 --> 00:41:17.440
And of course, the biggest compliment we can receive is
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00:41:17.480 --> 00:41:20.400
for you to help us spread the word to your friends, colleagues,
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and classmates. You'll find all the important links, as well
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00:41:23.119 --> 00:41:25.480
as info about our sponsors in the show notes, so
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be sure to check those out.