Medicine-in-Motion FAQ's

What is an "industrial athlete?"

This concept originated somewhere in the late 1980's. Through it we apply the principles of sports medicine to the evaluation and treatment of injured workers.

A lot of time and money has been spent evaluating athletes to discover ways in which to help them perform better. They’ve been hooked up to all sorts of machines monitoring their hearts and lungs, strength/endurance, analyzing their diets and whatever supplements they might be taking, etc..

Of course, this is all done with the best of intentions…….utilizing this information, the best athletes may look forward to winning Olympic gold. (Or perhaps lucrative careers earning obscenely high salaries, not to mention millions of dollars endorsing various advertising products...but I digress.)

Fortunately, the information gleaned from the athletic studies can easily be applied to the American work force.

Treating these workers as "industrial athletes offers several advantages:

FIRST -faster return to participation: the typical athlete wants to get right back into the game ASAP. They generally won’t stand for a doctor who tells them to "stay in bed for 3 weeks so that back can heal." Furthermore, we know that activity promotes more rapid healing and restoration of performance. [And, while the "Michael Jordans" of the world probably wouldn’t miss a few weeks of income, not many of us regular folks can go too long, as a result of an injury, without a full paycheck.]

SECOND -self-esteem is improved: the sports medicine team serves as cheerleaders in a sense. We psych up our athletes every step of the way through their recovery, filling them with positive reinforcement. We do the same for our industrial athletes. ["Doc says he’s treating me just like Joe Montana!" In San Diego: cómo Péle!]

FINALLY -Team physicians are important. Not only does a good team doc cover events, but we truly become a part of the team. We know our players and coaches. We understand the personality dynamics around the workplace, as well, and how this may affect a worker’s recovery. [It’s well-recognized that an employee who likes their job will return to work faster than one who does not! Also, if the employees feel comfortable with us, they may start to trust us with such things as the truth of how or when an injury really occurred.]

How was this website created?

Web Pages That Suck (by Flanders and Willis) was used to gain understanding for the basics of web design. After I planned out the site, I used Microsoft FrontPage 2000 to assist with the coding. No "canned" themes were used in the creation of this site. Buttons were created using Microsoft Image Composer (part of MS FrontPage 2000), with clipart from Microsoft Publisher. The web servers are hosted by Hostway.

I have insurance coverage for my medical care. Why can't you trust me and see me without my insurance card/proof of eligibility?

This is the unfortunate reality of business. You can't go to a department store, tell them that you have Visa, and then expect to walk out the door without showing them your credit card. Right? Unless you demonstrate proof of credit (i.e. your card), you either pay by cash/check or you leave empty handed.

A medical practice is no different. As much as we like to focus on providing quality medical care to the community, we still have to remind ourselves that a medical practice is a small business with overhead expenses (staff salaries, equipment, etc.) to meet. We have no way of verifying insurance eligibility unless you provide us with appropriate information for billing purposes. We are willing to help you verify eligibility, via a telephone call to your insurer or employer, should you forget (or not receive) your insurance card. Otherwise, expect to pay for services rendered at the time of your visit.

What is our policy regarding specialty referrals?

We often field requests for HMO referrals to specialists, e.g. dermatologists to look at acne or remove a skin cancer.

First, it is important to understand that family medicine is a specialty itself. The vast majority of family physicians are capable of taking care of a wide range of medical and minor surgical conditions without a need to refer out to a specialist.

Every physician should know his/her limitations. I, for example, have not delivered a baby in over 15 years. I gladly refer these cases to the local obstetricians. I do, however, perform well-woman exams, so these do not have to be referred out unless a patient truly prefers a particular gynecologist.

We have the capability to perform minor office surgical procedures such as biopsies and excisions of many skin lesions, as well as cryosurgery ("freezing" of pre-malignant and other benign skin lesions). We treat most types of common dermatitis and other skin conditions, as well. However, should a patient not observe appropriate improvement with my treatment, I would not hesitate to make a referral to one of our fine local dermatologists. These are but just a few common examples.

We do not make any referral decisions based upon insurance type or lack thereof! We simply try to do "what is the right thing" for our patient. If a specialty opinion is appropriate, I will make an appropriate referral regardless of coverage. I would never consider withholding or delaying a referral simply because someone had HMO coverage (this would be stupid, as well as unethical).

Incidentally, I always try to send my patients to those physicians to whom I would send my own family members. Be aware, though, that HMO plans often have limited specialty panels and I may not have a choice in some specialties.

How do HMO and PPO plans differ?

Preferred Provider Organization (PPO) plans provide freedom of choice with regards to your medical care. The costs of these plans has risen steadily over the years. In response to this fact, Health Maintenance Organizations (HMO) were created as an attempt to keep health care affordable for the average family. It accomplished this task, primarily through containment of costs and limiting panels of physicians.

A former associate of mine offered this excellent analogy:

Suppose that you want to go the shopping mall. You have two options to get there from your home: you may drive directly or take public transportation.

If you drive directly, you pay for the costs of your vehicle, the fuel, maintenance and upkeep, but you have the freedom to travel at the time of your choosing, as well as the route. (PPO)

Public transportation, on the other hand, will still get you to the mall. The monetary cost of the trip will be cheaper, however, it might not be as convenient - you might have to walk a few blocks/miles to the bus stop and the bus may have to make several stops along a long circuitous route, but eventually you will find yourself at the mall. (HMO)

With a PPO plan, you can usually choose the physicians that you like without need of a long referral process, so you can be seen faster in many cases. With the typical HMO plan, your choice of physicians within a particular community will be limited. It's quite possible that the best docs in the community might not even belong to the HMO.

In short, we get what we pay for. Convenience and quality has it's price.

[By the way, another term - IPA - frequently comes up in these discussions. IPA stands for Independent Physician Association. This is a contracting organization that serves as the go-between for practicing physicians and individual insurance companies. For example, Sharp Community Medical Group (SCMG) contracts with several HMO insurance companies (e.g. Secure Horizons, HealthNet) upon the behalf of practicing physicians.]

Dr. Pearson is not usually in the office on Thursdays. How can he take care of injured workers on those days?

Thursdays are the day that I used to consult for the Zenith Insurance Company, reviewing workers compensation claims, down in Mission Valley.

In general, you should always call my office and have me paged so that we can discuss what is best for the patient. Often, as in the case of musculoskeletal injuries such as a back strain, we can handle initial treatment by phone and schedule the patient to be seen the following day. However, I always have local physicians available for back-up to examine patients who absolutely have to be seen. [Dr. Stanley Weinberg (Escondido; 760-747-7512) and I cover for each other's industrial clients on our days out of the office.]

Please note that this is an evolving process for us. As our industrial client base continues to grow, we will consider hiring a physician to cover these Thursday hours.

Finally, most companies diversify amongst several vendors for their supplies. This way, if the preferred vendor is out of a particular product, another can come through with it so that work may continue. Along these lines, it is not a bad idea for companies to have other occupational medical clinics available for "back up" purposes. You may consider referring to these clinics on the days when I am not in the office. I recommend Concentra Medical Center, formerly the "Industrial and Sports Medical Center" on Nordahl Rd, San Marcos (my old haunt).

If you have any further questions/concerns regarding this issue, please call us to discuss how we may best serve your interests.

How can I get a copy of your mom's fabulous tabouli recipe?

Click here!

I love the artwork in your office - please tell me about the artists!

These were created by local artists Karen and Cara Ferguson (mother and daughter, respectively). Click here to see more examples of their work and learn how you can obtain prints for yourself. [NOTE: I've altered the pics slightly to guard against unauthorized reproduction.]

I just hurt my (choose one or more: back, ribs, ankle, knee, toe, etc). Why didn't you perform an x-ray? (Don't you need the money?!)

Quite simply, a good doc does not order a test unless it's going to change his/her treatment. While this might not be such a big deal when ordering cheap tests (do these really exist?), it becomes a significant issue when it comes to the more expensive technologies such as magnetic resonance (MR) scanning (MRI scans may easily exceed $1000).

There are numerous studies demonstrating the extraordinary amounts of money wasted on unnecessary radiographic examinations. For example, physicians in Ottawa, Canada, looked at the vast numbers of plain x-rays that were ordered for typical injuries to the knee, ankle, and foot. They observed that while most patients who arrive at emergency rooms with an ankle sprain are sent for an X-ray, less than 15% actually have a fracture. These physicians developed the Ottawa Ankle Rules, a set of guidelines that can help doctors avoid ordering unnecessary X-rays simply by observing how patients walk and by feeling their feet. These rules were recently validated, yet again, by a Swiss study that concluded that they "can rule out ankle fractures with almost 100% accuracy and cut down on thousands of needless X-rays every year." As a sports med doc, I've used these rules over the years and have yet to miss a clinically significant fracture.

There are occasions where the diagnosis of a fracture simply doesn't make any difference in the subsequent treatment. Fractures of the toes and ribs are probably the most common examples of these. All common toe injuries are treated by "buddy taping" the affected toe to the adjacent one, whether a sprain or simple fracture. In the case of ribs, they are composed of bone and cartilage, the latter of which cannot be visualized with routine x-rays. Rib studies are notorious for missing rib fractures. For example, I cared for a patient involved in a motor vehicle accident who complained of left rib and flank pain. Plain films obtained by the emergency room physician were interpreted as being negative for fracture. When I saw him, I was concerned for a possible spleen injury so I ordered a CT scan of the region which revealed the presence of 7 broken/fractured ribs! Regarding their treatment, we do not apply casts to chests for rib fractures as this would compromise breathing (we even try to avoid rib belts, if possible, for this reason). Hence, painful ribs are treated with analgesics ("pain killers"), ice and then heat, etc - whether they are broken or merely contused (bruised). Bottom line: no need for rib x-rays unless we clinically suspect a more severe injury such as a pneumothorax (and then the radiographic study of choice is a chest x-ray looking at the lungs, rather than a rib series).

I could go on forever on the subject of imaging the acute (fresh/new) low back injury. The fact is that out of 100 back injuries, less than 5 will ever require surgery, including many disc herniations. Plain x-rays cannot visualize muscles, discs, nerves, or ligaments, nor can they identify facet subluxations (the "kinks" that patients commonly present with in the office). MR imaging can identify the majority of disc herniations/protrusions, but we would only order MR examinations if surgery was being considered because, as just noted, the majority of patients with acute disc injuries get better without surgery. The natural course of acute low back pain is well-recognized, as are the treatment options. Early imaging studies do not add anything to the management of the typical case of acute low back pain. Of course, exceptions may exist and there are some "red flags" in the patient's history that we look for in order to identify who might really have an underlying condition warranting further investigation. The National Guideline Clearinghouse (U.S. Government) has published it's guidelines for the evaluation/management of low back pain or sciatica in the primary care setting. (They may be found here.) Finally, a brief summary of the treatment of low back pain may also be found at the Quackwatch site here. [And don't forget to read my patient education handout on the treatment of acute injuries elsewhere on this site!]

Oh yeah, could we use the money? Sure, but we have to live with ourselves ethically and do what's right for our patients. Bummer.....

Frequently Asked Questions (FAQ's)

What is sports medicine? What does **"medicine in motion"** refer to?

**What does "Running water never freezes..." mean?**