Caring for the new PI patient .. 12-11-98

Question:

 Although when in school we get a lot of useful information and 
training, sometimes when we get in the field we are in wonder of what 
exactly to do for our patients.
 I have my first car accident (whiplash) coming in tomorrow and I find 
myself a little nervous. I know besides doing the exam, x-rays and 
tests, that I will of course adjust the patient and have them do some 
active range of motion execises at home but, besides the adj's and 
execises what else can I do for my patient(I live in Mi. so we don't use 
any types of modalities).
 Thanks in advance for any advice.

Apprehensive Doc, 

My reply:

Thanks for the e-mail .. the answer is quite simple .. in fact .. very simple. There is nothing 
different between taking care (the adjustments) with PI folks than just regular patients .. the 
difference is within the paperwork and preparation to be a witness if called for (probably not). 

Excuse me if I forget if you were my student or not .. but if yes .. get out your Smart Start Book 
and read Chapter 8 concerning PI work. If you have my disk .. call here at 770-491-3639 to order 
one if you don't have it .. copy the narrative onto your computer and use this format .. but before 
you even get that far .. copy the PI case history form that is found in Chapter 2 .. place your 
letterhead on it and have them fill it out (or use whatever you already have on hand) .. But .. be sure 
to spend time to write exactly what happened during the accident (copy these questions and ask 
them one by one) .. was he the driver .. how fast was he going .. if stopped was it for a light or 
traffic .. was he the car in front or another before him .. upon impact did his vehicle go forward and 
strike the car in front .. if it did go forward how far (door length .. car length) .. was his foot on the 
brake .. was his head turned to the right or left .. did his skull strike the headrest upon 
hyperextension .. did his upper back strike the seat hard .. did he flex onto the steering wheel .. did 
the shoulder harness engage strongly upon his chest ..  was there a lot of force into his shoulders as 
he held tightly against the steering wheel .. did his knees strike the dashboard .. did his arm strike 
the door .. how long did he sit within the car before he got out .. if he stayed in the car why .. 
because he hurt .. disoriented .. dizzy .. fearful .. when he left the car was he weak kneeded .. did 
he have a headache or pain anywhere .. when did he start to feel any symptoms .. where were they 
.. did an ambulance come to the scene .. did the paramedics check him .. did they recommend he go 
to the hospital .. if he didn't go with them but went latter that day .. why .. if he went by ambulance 
was he on a strecther .. with a cervical collar .. which hospital ..what did they do .. did they release 
him with medication and advice to seek professional help later .. did they give him an excuse to 
refrain from work .. for how long .. what kind of work dowes he do .. will his symptoms effect 
him at work .. how did he feel the rest of the day .. the next day and the days before seeing you .. if 
he went to a hospital (have him sign a letter requesting x-ray and ER report from the hospital and 
either have them fax or send them to you .. they will .. write a simple one up .. patients name .. 
birthdate .. SS# .. day he was seen and request for x-ray report and ER notes .. patient signs you 
fax it to the hospital ER or send it to them) note the days and names of MD's or clinics he's been 
before you and what was advised or done. Has he had any previous accidents where treatment was 
rendered .. was he released .. when .. has he had symptoms since being relaesed.. in his opinion is 
the symptoms he has now due to the accident you are seeing him for.

That's it ..

Now after you have written this all down either on a plain paper or the side of the case history form 
(where I do it..before to date it and have the patiernts name and accident dtae real clear) .. go to your 
computer and write this out .. if you want .. e-mail me the report and fax the notes to me 770-491-
3799 .. and I'll clean it up .. this my good man is your narrative and deposition info if needed.

During the examination .. be sure to get clear numbers of range of motion in neck and lower back 
and note any areas of spasm. Depending on the symptoms and the mechanics of the accident .. you 
can probe more. Note this as well. After this is all done and you placed it in your computer and you 
cleaned it all up .. you can send a copy to the insurance company along with the firsat claim and the 
attorney if there is one.

BUT .. there is no difference in care or treatment .. accidernt cases respond like everyone else. They 
may need to be seen daily .. and if they are really hurting and need time off from work (give them 
no more than a week to start) be sure they are able to handle it and won't get fired from their job. 
Also .. keep good daily notes .. just jot down how they are doing and where you find trigger points 
.. spasms .. any specific listings etc .. visit by visit. If you adjust all the areas of the spine .. be sure 
to note this on the daily SOAP report. 

Good Luck and keep in touch.

Dr. M