DrRic Patient -Frequently Asked Questions: Should I see a specialist? pt 2

So lesson from last time -"trust your gut feeling when someone hands you a bogus answer".   I expect my consultants to give an expert opinion on a diagnosis, then I expect them to get back to me. Used to be in the 90's a phone call would be made after an evaluation and plan created.   I understand with low insurance reimbursement that docs have to move patients like cattle to pay the bills, call me old fashioned, I still expect when the door is closed, full attention to whom ever I send for second opinion .

Here is the flipside: my patients know I spent extra time after family practice residency in a sports medicine fellowship. There are a handful of teaching centers in Illinois that many graduates apply for but only few get in. Most of us in primary care sports medicine are dedicated athletes or just love the musculoskeletal part of healing/health. I think it's fantastic to know how to prevent asthma attacks with changing shoulder and upper back strength or improve post partum sex with pelvic therapy. (It aint just knowing how to test for an ACL tear or pop a shoulder back in)   Anyway.....I remember taking a state written exam one year with a bunch of docs, saw an old friend who graduated a year ahead of me.   I was psyched about my sportsmed fellowship and mentioned....."you should consider it as well for more clinical experience" (your average family medicine residency entails 3 years of training and most programs offer 1 month of orthopedic assisting in surgery or a sports medicine rotation").   His reaction was "a sprain is a sprain".   I honored his opinion but thought to myself, no way am I going near his clinic with any body ache, sprain, tear or dismemberment. It's good to know first aid, RICE and how to write a note for work/school ...but......spending 4 weeks with splints/narcotics and a pending second opinion vs just 1 week with a handicap when the injury should have been rehab-ed from the start is a gia-normous waste of time!!!!! On top of that, after 2 weeks of time off the body has now deconditioned, gained a few pounds, developed constipation and drowsiness from the meds plus a little reactive depression from not being able to exercise. My job as a doc is to help compress the time frame of healing. Every case is a little different, every personality with its individual desires, every brain has its own tolerance to pain so not all treatment plans fit each person.   (I scoff at hand-outs that say do this 20 repetitions 3 times a day as the sole basis of "rehab") It does make a difference to see a well trained doc for the symptoms suffered.

Obviously I cant speak enough for the specialty of primary care sports medicine. Even if you aren't an athlete, kinesiology/musculoskeletal medicine/disease pathology all play into designing the best way to get someone to optimal health. (ie....if I have an out of control diabetic who is obese, I wont just say "lose weight by starting a walking program" ... I'd get physical therapy involved, make sure his/her nutrition knowledge is maximized for her activity, then steer her toward and exercise physiologist for brainstorming a sustainable fun calorie burning activity.) True sports medicine looks deeper than just exercise injuries.   So how to choose a doctor:

1-Primary care sports medicine fellowship trained (just ask the office if the doc completed a fellowship)
2-Orthopedic surgery is different in that all specialist can "cut". I like sending my patients to an orthopod that has trained specifically for the region of the body involved. (ie.....one of my favorite shoulder guys is Tony Romeo from Rush/White Sox, most young grads have gone through enough knee scopes that they all know about ACL/meniscus repairs-so for the knee guy I go for the best bedside manner, hand injuries still go preferentially to hand surgeons.)   A must for any of my "Pods" is good bedside manner. There used to be a magnificent hand surgeon that worked down the street when I was with CDH. His talent in the OR was famous.....so was his anger.   Dude used to throw sterile instruments to the ground and have a tantrum if everything wasnt perfect. I guess thats ok if he is looking out for you but I dont use healers that hurt inside or outside the office.
3-Chiropractic physicians have excellent training around Illinois so I like the ones that listen in and get the true dynamics of the patients pain. The chiros I use have turned pain/function around faster than patients going through conventional methods. Dr Joe Musolino in my office does great work, graduate from National University in Lombard. Great communicator with me and physical therapy and this is what gets people better fast-coordinated efforts between all providers.   You have to research training and experience and see how they are active in the community.   Just like medical schools, if the chiro school has been around for years and continues to expand curiculum, probably a good school. On the flipside, I spoke with a DC that took care profighters in MMA, he just wanted to refer patients to me for writing scripts of anabolic steroids, saying alot of docs he refers to do it for him. (obviously fell into the dark side of healing for the glory of rubbing shoulders with the rich and famous.....doesnt have to be that way-see my pics!)
4-Medical Acupuncturists are powerful in their own world of healing (and have been for the last 2500 years) When combined with conventional healing, I consider bringing them in like calling a left handed pitcher to a tie game. For any injury that has plateaued or if an athlete needs to get better fast for a fight, game or match in 2 weeks-call in the needle doc!   I originally studied medical acupuncture at UCLA to see if I could speed up healing while waiting for the physical therapy HMO referal to be approved. When I used it, it worked like a charm, sometime the patients would get better and not need therapy or surgery second opinion any more. Ahh...unfortunately, insurance caught on and discontinued covering acupuncture as a benefit so I had to retire my skill. (Only bring them out for special cases like in getting my pro MMA fighters to relax before a fight....see my pics!)

So if you are injured at work, in a league event, or during training; dont be embarassed to ask your provider what kind of training s/he went through. If it seems like the injury is taking longer than expected, seek out one of us (see above) and get better faster!!!! A "sprain is not just a sprain".