You’ve been injured. It’s awful. The injuries can range from needing surgery to prolonged stays in the hospital to extensive brain testing using DTI/MRI. Or you have sore back. Any way you look at it, it is not good and it must be dealt with. But what happens when some providers won’t see you because you are a crash or injury victim? What about the paperwork you got in the mail from your health insurance company? Or from Optum? Or Conduent? What do these documents even mean???? What type of doctor should you see? Are they all the same?
Getting appropriate medical treatment after you’ve been injured in a crash or a fall is THE top priority. So where do you start?
The emergency room is most, but definitely not all, people’s fist stop post car crash or fall. Keep in mind that the ER is there to handle serious emergencies. Most trauma injuries do not fall into the ER definition of emergency. Typically, you will get a CT scan and evaluated. You will also get a prescription for Tramadol or some pain reliever and sent on your way. The ER is just not a place equipped to diagnose and treat soft tissue injuries like herniated discs or torn rotator cuffs. They will typically identify your fracture or acute traumatic injury. They will also likely catch the serious head injury. But identifying the mild brain injury is tough at the ER level. The patient is usually the historian and taking a history from someone who may have a brain injury isn’t the best idea. The ER may also refer you to an orthopedist or a surgeon if your injuries warrant it. Make sure you follow up with that referral. It is your health and your body. You are responsible for it. Pay close attention to how you feel, how you sleep and how you interact over the next few weeks. Your health depends on it.
Primary Care Physician
Most people will make a call to their PCP to arrange an appointment. It’s the natural reflex. But your PCP may not be the best doctor to handle your musculo-skeletal injuries. Your PCP is great at managing your blood levels, allergies and the flu. But most PCPs are not equipped to handle someone in a recent trauma. Here is a simple way to find out when seeing your PCP post-injury:
Did the PCP order an MRI? Most neck and back injuries do not show up on x-rays or CTs. An MRI is needed to assess the soft tissue damage. Failing to order this can leave serious injuries unaccounted for and undiagnosed.
Did the PCP look for signs of a head injury, EVEN if you don’t think you lost consciousness or hit your head? Many MTBIs (Mild Traumatic Brain Injuries) occur absent loss of consciousness or striking your head. Your brain is suspending in fluid in your skull and moves in many directions during a traumatic event. Brain injuries and concussions are among the most missed diagnoses. And they are among the most debilitating injuries. A script for Tramadol for your headache is NOT taking care of you.
Did your PCP refer you to a chiropractor, physical therapist or orthopedist for further evaluation? Trauma to the human body requires a specialist to evaluate you. You PCP is the first line of defense but they should know you need to be further evaluated, even if the symptoms are mild. Why? “Mild” neck injuries develop into serious injuries over time if not treated. “Mild” shoulder soreness can develop into frozen shoulder or be symptomatic of a tear in your rotator cuff. Failing to get you into the hands of a specialist can cause permanent harm that could require surgery down the road. Even if you think you “aren’t that hurt.”
If your PCP is doing the above, you are in the hands of someone who really knows what they are doing. Consider yourself lucky. Most PCPs are so overworked and booked they really don’t have time to do all the above. Reimbursement by health insurance is really hurting them. They are working hard but it is tough to balance the time. Do not be afraid to address this with your PCP and/or ask for a referral somewhere. Be persistent. This is your body and your health. You are responsible for it.
Physical Therapist/Doctor of Physical Therapy
A PT/DPT can help you rehab in much the same way a chiropractor can. They can perform a variety of treatments to get you back in shape, including stability and strengthening. It is important to note that your medical doctor or chiropractor must refer you to a physical therapist. You cannot just pop in without a referral—you can do one visit with them usually but thereafter you would need a referral from a physician. The PT will also work with you post-surgery to get you up and running. You may also see a vestibular therapist if you are having balance trouble. This therapist will work with you on coordination and maintaining balance. Many MTBIs clients need vestibular therapy. Do not be afraid to ask for it. A PT cannot order an MRI/x-ray/CT.
A Chiropractor is trained to handle the back and extremities. There are a variety of specialists among chiropractors. Some people may not go to the PCP post incident and may go directly to a chiro. This not a bad idea, especially if the injury is more of a nagging type situation. A chiro can order MRIs and x-rays. Ask for an MRI. This can help them identify disc or shoulder injuries that do not show up on x-rays and CTs. The chiro will perform various orthopedic tests on you, testing your strength and deficits to identify the origin of the injury. Many times a shoulder injury will actually be a neck injury that is radiating into the shoulder through a nerve. A chiropractor will usually prescribe therapy for a certain period of time. If you reach a plateau during that time, typically the chiro will refer you to a physiatrist or orthopedist. If you are seeing the chiro for an extended time (over 5 months) without relief or referral up the ladder, you need to ask why. Your goal is to improve so don’t be afraid to ask why there is no referral if you need it. A good number of people obtain relief from chiropractic treatment. That is great and it can work well. For those that don’t, you need to continue the fight.
Physiatrist or Pain Management and Rehabilitation (PM&R)
This doctor is typically the next stop if you aren’t receiving chiropractic relief. This doctor can also work with the chiro in getting you back in top shape. A physiatrist will typically administer injections to relieve pain and bring down inflammation. These injections can vary from trigger point injections to full on epidural steroid injections.
These are a series of injections, typically using lidocaine, that the physiatrist will inject into certain points in your body. It should relieve the pain and bring down inflammation.
This will allow the physical therapist or chiro to rehab you a little more aggressively and get you back in top form. These are typically administered in the office by the physiatrist. The needle is smaller and it is not as invasive as the epidfurals. Relief from this varies and may only be temporary.
These are known as ESIs. This is more invasive approach to the pain and injury. This procedure is an outpatient surgery typically performed at surgery center. You may be administered some medication to relax you. The physiatriust will usually use a large needle to inject a steroid into the painful area. Typically, the doctor is guided through fluoroscopy—a camera that can show where the needle is in your body. It is more invasuive than triggers and can be very painful. However, some people obtain relief with these. If that is the case, you will usually get these shots every 6 months or so. If you do 2-3 rounds of shots without significant relief, you will likely be referred a surgeon.
This is usually the last stop full on surgical intervention. The doctor is going look at the treatment you’ve had and evaluate the injury. Surgery may be a viable option at this point as you are running out of options to fix the problem.
this is a doctor who specializes in dealing with muscles and bones. They can do a lot of trauma work. The also usually do a lot of work with shoulders, knees and hips. These doctors perform rotator cuff surgeries and hip surgeries. They may also perform some hand/foot/wrist but likely will refer you to a specialist for that.
This is a doctor who specializes in the neck and back. This doctor will work with your orthopedist if you are having shoulder or extremity trouble. This doctor performs cervical (neck) disc replacements, cervical fusions, lumbar (low back) disc replacements and lumbar fusions.
Podiatrist (DPM)/Hand and Wrist Surgeon
These doctors work exclusively in the feet and hands/wrists. There are a tremendous amount of bones in the feet and hands. Therefore, specialists have developed techniques to treat these injuries. Many injuries to these body parts are often overlooked. For example, a lisfranc injury to your foot is a common injury from a car crash but can be missed if your treating doctor is not vigilant. Recurrent pain in the arch of the foot can be a lisfranc injury. A doctor of podiatry can look at this and prescribe ways to treat the injury. Another commonly missed injury is the torn scapholunate ligament in your wrist. Many people can have wrist injuries post car-crash or fall for a variety of reasons—gripping the wheel really tight, etc… You need someone who can identify these injuries and get you the treatment you need. An hand/wrist specialist is exactly that.
A neurologist is a medical doctor who works with the human brain. In the injury world, this doctor will typically address anything from a brain bleed to MTBI. These doctors are important for brain injured victims to find. A good neurologist who is willing to really work with you on your brain injury is a godsend. They can make a world of difference. A neuropsychologist is usually a PHD/psychologist who will administer a variety of cognition tests to discover your cognitive function after a brain injury. This is a very nuanced are of science and can be very subjective. It is important to find a neuropsych who understands your injury and deficits. This way, they can administer the appropriate tests.
If you are having trouble getting the appropriate care, we can help. We’ve dealt with thousands of people who have injuries from incidents like yours. Each client is different but it is important that we, as your advocates, make certain you get the attention you deserve. Your health is the #1 priority. We, as lawyers on our client’s behalf, have an absolute obligation to get you back in the position you were before the injury. And if that means you need help finding the best doctor in the field, we will help you as best we can.