If you ever have a car hit you WHO YOU GONNA CALL? No... Not Ghosbusters! but your friendly neighborhood law buster who just got a nice little settlement for your friend's girlfriend. This is indeed the only civilized country in the world where after a car accident you often call your lawyer before the police or the ambulance (of course your lawyer will insist that you call an ambulance and got to the ER. It is all for the GOOD OF THE CASE...Never mind the cost of all this and never mind that you are tying up valuable resources that you really do not need for that mild whiplash injury).In the ER, first comes imaging. You absolutely need to document. If you do not have a herniated disc you do not have a case. The radiologist knows that so s/he after obliges. Their motto "Every horse is a zebra". Thus every other bulge becomes a herniation of some flavor. Radiologists never get penalized or sued for over reading so why not oblige. It is good for business. Of course the more herniated the disc is read to be, the more of a license to cut the surgeon will get, carrier beware. The sad truth is that MRI is becoming more and more a test for lawyers and judges more so than a diagnostic tool for providers. Jurists are seen in court brandishing these films and daring each other as they submit the jury to a grueling deciphering of these very fancy and elusive pictures. Doctors safe happy to tutor...for a fee! It is all fine and dandy but the price of this expensive "black-and-white two-dimensional as you lay very still and horizontal" (so unlike real life!) test is close to a grand!
At the center of all the fuss resides the chiropractor MANIPULATOR PAR EXCELLENCE. First every patient has to receive a set of x-rays when they walk-in and every single patient is then told that they have something out-of-wack in their spine. Of course the patient is never told that even a slight movement of the neck up down or sideways, while x-ray is taken, will cause a pseudo-abnormal x-ray thus providing the chiropractor a license to manipulate....for ever and ever...or should I say until the insurance benefits run out! Most treatments in healthcare are time-limited, e.g. antibiotics for 10 days, nsaids for 2 weeks, cast for 6 weeks, etc. Only chiropractic is indefinite, more so if you have a personal injury case. Isn't this strange?
The big spoiler is the Independent Medical Examination (IME) whereby a doctor completely foreign to the patient or his/her case, often from another state, is hired by the carrier to "objectively" examine the patient and determine if any more treatment is needed and what. These doctors are usually IN DEEP with the carrier not independent in the least. They proclaim from the get-go that they do not have any doctor-patient relationship with you and will be only conducting some sort of forensic examination in relation to the accident and the alleged injuries. Many patient describe that examination as very cursory and often borderline hostile. These IMEs are very lucrative and often times paid in full upfront (a true dream for doctors who often have to fight tooth and nails to get paid 50% of what they billed). Neurosurgeons and orthopedic surgeons can literally make $1 million a year just doing IMEs. Some of these IMEs can lead to depositions or court testimony...this means more upfront no hassle moola! These would be considered Defense-doctors and their sole focus is to cut-off the care and get the carrier of the hook. The more they do that and the more business they get. So much for independence. Essentially these doctors have read the Hippocratic Oath upside down for they aim to deny care instead of providing it and the "do no harm" is out the window.
Indeed in compensable and personal injury cases, often more money is spent by carriers on these IMEs that deny care than on actual treatment! This IME practice would be a sad reason to go to Medical School and I have yet to discover anything similar in Western Europe for instance.
