Case Studies

7/27/2017
Dear client,
I have come across several interesting cases in the past few weeks and I would like to share those with you to help you avoid costly surgeries and reduce your Worker’s Compensation costs.

About Dr. Refaeian M.D.

I have practiced occupational medicine on the full-time basis since 1998 in El Paso and I currently serve as the president of El Paso Pain Society and teach at Texas Tech medical school as an assistant clinical professor. I believe these cases would help yourself or anyone in the medical field in general to keep an eye on these complicated cases and to resolve them in a timely fashion. This should reduce your EMR (Experience modification rate) and your insurance premiums and injured employees satisfaction.

Case #1
2augcase126-year-old otherwise healthy male presents with complaint of severe lower back pain when working for a construction company driving a tractor. He was already seen by an occupational clinic and was not happy and went on his own to an urgent care facility. They took x-rays and I told him that he had a pinched nerve and needed physical therapy for 4 weeks and he was placed on restrictions that he could not drive a tractor. The patient was so upset that he had to hire an attorney and he wanted to take further action. He was seen in this clinic approximately 2 weeks ago and physical exam was positive for diminished range of motion otherwise no evidence of pinched nerve noted on examination. X-ray of the lumbar spine shows evidence of severe degenerative disc disease at L5-S1 which explains his situation and his pain. I fully disclosed the x-ray findings to the patient and he was very grateful to finally know what his problem really was. X-ray findings are attached for your information. In my opinion in the Worker’s Compensation setting or any other setting for that matter, the most important step is to make the accurate and timely diagnosis. Patient understood the diagnosis and dropped his lawyer and went back to work in just 2 weeks. Simply referring the patient to do several weeks of physical therapy , excessive medications, time off from work and unnecessary injections or surgical procedures are not the answer that most patients are looking for. This case could have been a disaster if those steps would have been taken.

Case #2
2augcase258-year-old female was referred for MMI/impairment rating and despite the surgery and several weeks of physical therapy she continued to be symptomatic. The physical examination revealed evidence of various deformity in the left knee and x-ray findings give us the answer. X-rays were performed weight bearing which showed bone-on-bone degenerative changes in the medial knee joint. In the past she has had regular x-rays and MRIs which noted mild degenerative changes which did not explained her situation. Patient was advised that additional 4-6 weeks of physical therapy that was requested by her orthopedic surgeon would not have made any difference in her situation and more than likely she would’ve needed to have total knee replacements which was found not to be related to her occupational injury. Again this case could have been treated on a very lengthy and chronic basis without knowing the accurate diagnosis. X-rays are included for your viewing.

Case #3
2augcase368-year-old male presented with complaint of pain and discomfort to the left hand and he had 4 weeks of physical therapy without improvement and he demanded MRI and orthopedic surgical referral. X-rays of the affected hand shows evidence of severe degenerative changes in the left fifth digit at the DIP joint (previous x-rays were read as normal). Patient was informed of the findings and all the options were discussed and he decided to take the medication route. This case could have also been treated on a very lengthy basis with multiple orthopedic referral and therapy which was all avoided once the accurate diagnosis was made. X-rays are attached for your viewing.

 

 

Case Audit Summary

Conclusion
I believe that I have came across many complicated and serious Worker’s Compensation cases in the past 20 years and our clinic should be able to help you avoid excessive delay, cost and unnecessary injections, surgery and physical therapy for your patients. Patient satisfaction all begins with prompt and accurate diagnosis.

Sincerely,
Manouchehr Refaeian, MD