When evaluating a patient, we rely on a good history to help us form a differential diagnosis. We use our physical exam skills to refine that list. A bedside ultrasound or ECG can further guide our decision-making and save precious time. Beyond these, we rely on seemingly failsafe data: radiographs, blood tests, and urine samples. But sometimes these reliable tests aren't so reliable.
As disease patterns evolve, so too must we. Being aware of emerging illnesses and remaining diligent in identifying their presence ensures a safe environment for the patient and the community. Measles is a highly contagious and potentially lethal viral infectious disease.
Recently we were asked to attend an IME and was struck by how unprepared the client was for the exam. Throughout the IME this person gave answers that we believe could potentially be detrimental to his case. The client spoke up in an effort to be helpful and forthright. These answers were volunteered without prompting by the examining doctor. It was difficult to sit through the IME as an observer and not ask the client to only answer the questions asked and not volunteer information that could be misconstrued by the IME Physician. The position must be taken that IME physicians may be no less susceptible to secondary gain issues than some clients.
When joint problems escalate to the point of needing special treatment, it is time to research orthopedic surgeons. As you consider your treatment options, it is important to choose an orthopedic surgeon who can accurately meet your needs. To ensure that you make the best choice, identify your needs, do your research, and ask the right questions.
There may be more to the complaint than meets the eye. There may be obvious issues, such as a failed component resulting in a fall, a skin breakdown that on the surface appears that it was as a result of overuse or a rough area within the prosthetic socket.
Foot and ankle injuries due to motor vehicle accidents (MVAs) present unique challenges to the astute foot and ankle physician. Even more challenging than the pathology, however, is ability to return to pre-injury level. Published medical literature provides strong evidence for risk of post-traumatic arthritis after a heel bone (calcaneus) fracture - this post-MVA condition can manifest as residual deformity and resulting arthritis, thus precluding the ability to rapidly return to pre-accident levels. Hence it is imperative that an erudite foot and ankle clinician ascertain the appropriate treatment and long-term prognosis of foot and ankle injuries due to MVAs.
1986: Crocket, Dolsky, Lack, Leventhal, Nathanson and Jackson visited London, France and Italy, observing surgeons using different modalities at that time and then brought back their information and openly taught liposuction in the United States under the auspices of the AACS. Other early teachers were Elam, Fenno, Tobin and others.
As part of their educational process, practitioners of manipulative procedures are made aware of the possible association between neck manipulation and cerebrovascular accidents[i] (CVAs) as well as what to do in the event a CVA occurs during treatment.[ii] For any litigation considered regarding a stroke that closely follows spinal manipulation, the starting point for retained counsel is to ask what else could have caused or contributed to the stroke. Screening issues to consider include the following:
Lawsuits pertaining to injuries from laser treatments gone awry or just not as expected are on the rise. Part of the issue is the lack of objective training protocols. There is relatively vague legal language across many state medical boards and often lax regulation of these procedures, who is allowed to perform them, and what training and supervision is required.
Following a neurological event such as a traumatic brain injury, cerebrovascular event, multiple sclerosis, etc., the medical needs of the person are of primary importance initially, for purposes of survival. As medical treatment proceeds and the survival needs of the person are met, the team of rehabilitation professionals will be established in an attempt to improve upon function performance in order to sustain quality of life. The rehabilitation team may be composed of a physician, physical therapist, occupational therapist, speech therapist, recreational therapist, vocational specialist, case manager, the psychologist, social worker, and nurse, to name several. It is often during this tim e that additional medical and rehabilitative needs are identified through diagnosis or observation by member s of the rehabilitation team.