What Kind of Doctors/Specialist Should I See and Where Do I Start?

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post-accident medical treatmentPost-Accident Medical Treatment

When you are injured in an auto accident it can be a very scary process. Most people are upset, a little confused, not sure what to do and it can be very unsettling. If you feel bad, sore, shaken up – the first thing you should do is seek post-accident medical treatment by going to an emergency room and get checked out. It is not necessary to go to a level 1 or level 2 trauma centers as you will know initially whether you need such a facility. However, many people can be injured or hurt in auto accidents and still need emergency room care because the high adrenalin rush that comes from being shaken up after an auto accident can mask the pain and other symptoms of an injury.

These less noticeable injuries in auto accident are not catastrophic but yet can be just as debilitating. For example, many of the injuries in auto accidents are related to tearing of the disc between the vertebras in your spine. Thus, when the fluid inside those discs leaks out, since it is contained in the central nervous system, it can impinge on nerves, the spinal cord, nerve roots and cause pain or numbness into your arms, hands or legs into your feet. Every case is different, every person is different. Some people just have general pain while others have radiating pain but it can take several days or weeks to fully develop.

Usually, someone will feel uncomfortable or some sort of pain the day or the morning after an auto accident, but the full extent of the pain can go unnoticed for a few days or up to a week or two. This can happen because while the initial injury occurs during the auto accident, the injury continues to develop and worsen over time. This can happen due to swelling of the soft tissues that were damaged in the accident or the tear of the disc could get larger over time and more fluid in the disc continues to leak out. There are also chemicals that are produced in the discs that affect nerves and can cause pain. Thus, unlike a broken arm which is noticed right away, many of the injuries that occur in auto accidents take time for the person to fully realize the extent of the injury.

The other type of doctors you may see if you’ve been in an auto accident are orthopedic surgeons. Orthopedic surgeons do surgery on the shoulders, knees, hips, ankles or wrists. There are sub-specialties under orthopedic surgery such as hand specialists that will handle certain aspects of your hand as well as doctors who specialize in hip and knee replacement and general orthopedic surgeons who do all of the above. There are even a growing number of doctors who actually do arthroscopic procedures on the hip which is a relatively new advancement in the medical field.

An additional type of doctor you may see in an auto accident is a neuro-psychiatrist. Neuro-psychiatrist are post-accident medical treatment doctors who treat patients who have an emotional or physical issue or closed head injuries and injuries of the brain. Many people involved in auto accidents will have either a mild closed head injury or moderate to severe head injuries. This means that while the scull is intact, the movement of the brain inside the scull may have caused some damage to the brain. The human body was not designed to absorb the forces involved in a car crash or accident and even a relatively minor accident can cause the brain to move in such a way that could cause injury.

The primary purpose of these doctors is to assess whether a patient has a closed brain injury and then whether that person can receive treatment to get them back to the level of comfort and normalcy they had before the accident.

Some of the signs or symptoms of a closed head injury are trouble remembering things that they use to remember easily. This doesn’t mean that you can’t remember something it but it takes more effort or time for you to remember. Additionally, you could also black out, have speech problems, have short, mid or long term memory loss or other signs and/or symptoms of a mild to moderate or severe head injury.

Why Should I Go to an ER?

Injuries, especially related to muscle spasms, soft tissue and/or swelling can be helped tremendously by going to an emergency room, being seen by a doctor and prescribed muscle relaxers that are anti-inflammatory right away. Emergency room doctors know that the more swelling you have in either your neck or back or whatever area is injured in an auto accident the more scar tissue that that can develop. The more scar tissue, the greater chance it is to wrap around nerves in the body and cause pain.

Additionally, when muscles are injured during an auto accident they spasm. That spasm can be painful and can cause additional scar tissue. Thus, by immediately taking anti-inflammatory muscle relaxants you can reduce the swelling and keep the muscle spasm to a minimum – thus lessening the chance that you will have a permanent injury or if you have a permanent injury due to the scar tissue buildup, it will lessen the impact of the injury.

Another reason for going to the emergency room after an accident is that some people may have tears or other injuries in their knees, shoulders, wrists and it is important to tell the doctors of not just those injuries but any other pain or injuries that you have because under Florida’s new PIP Laws – if you don’t mention all the injuries at the first visit, your own insurance coverage may not pay for all the injuries but only the injuries that were recorded at your doctor’s visit.

It is also common for people to discover due to back pain from the accident that they have small fractures in their vertebrae. This type of injury is found most often with women; particularly older women due to osteoporosis or weakening of the bones. Women in general are considered to be more susceptible to serious injury in an auto accident due to their smaller stature than men and other physical difference.

Whether you are male or female even if you do not feel severe pain, you should go to the emergency room after auto accident.

Doctors You Should Not See

Some doctors that you shouldn’t see after an auto accident are your general practitioners. The reason for this is most do not take PIP coverage and if you are in an auto accident PIP must be used first stethoscope before any other types of insurance. What this means is – even if you have public or private health insurance they will not accept a bill from a doctor because they know you have to use PIP first.

The end result is that the doctor will not get paid if he doesn’t bill PIP and almost all general practitioners do not have the ability to bill PIP. The cost of the programs and compliance updating is very expensive for the doctor’s office and if the general practitioner doesn’t have a significant portion of their patients who are injured in auto accidents it does not make economic sense for them to invest in those types of software or other types of documentation that is necessary for proper billing of PIP.

Thus, after you’ve been to the emergency room you need to follow up with a facility that can actually bill for PIP insurance. We strongly recommend that you see a medical doctor based facility. What that means is a facility in which there is a post-accident medical treatment doctor who is on staff and that doctor is the one who is in charge of the medical treatment of the patients. What you want to avoid is simply going to a chiropractor and letting just the chiropractor dictate your medical care.

Sometimes it is okay to initially see a chiropractor, but at the same time or shortly thereafter see a post-accident medical treatment doctor so the medical doctor can set up your plan of treatment, recommend a course to get you as well as possible, prescribe medications, send you for any diagnostic testing (ie: x-rays, MRI’s) that they feel is necessary to diagnosis the cause of your pain.

Many facilities have doctors on staff and as well as chiropractors, massage therapists and other types of medical professionals who can help see you through your treatment. Some medical doctors who treat people who have been injured in auto accidents don’t have those additional facilities in their office and will refer you to a chiropractor or rehab facility for your follow-up care. Both methods are fine but it is better and easier to have as much information at the doctors hands as possible. If all your injury care is being given at one particular facility then the doctors will have easy access to the most up to date medical records and be able to manage your course of treatment with the most updated information.

However, if you go to a facility where everything is not in-house you can still receive very good quality care they just may not have access to your most updated information at the time you see the doctor which may take longer for your treatment to be coordinated between facilities.

What Kind of Doctors can See Me?

There are a number of different doctors that you can see after you’ve been to the emergency room. You can see any physiatrist which is a physical therapy doctor, an orthopedic doctor, a general practitioner who works at a facility that accepts PIP, a neurologist – there are an infinite number of doctors who obtain the proper training to treat people who have been in an auto accident. Many facilities have medical doctors on staff and as well as chiropractors, massage therapists and other types of medical professionals who can help see you through your treatment.

The main issue in seeking a doctor after an accident is ‘do they have experience treating auto accident victims and is that experience more than just the occasional patient’? Like any doctor who specializes, the more experience they have on a day to day basis with particular types of injuries the better they are at helping their patients recover specifically in regards to injuries sustained in an auto accident.

What Types of Tests May the Doctor Run?

Generally after you have sought follow-up care for auto accident injuries (if your pain persists) the normal medical protocols will call for you to have not just an x-ray but an MRI of the area that is hurt. This is for areas such as your neck, back, knees, shoulders, wrists, spine, ankles and even your hips. MRI’s and X-Rays are known as “diagnostic tests” and while primary care doctors can interrupt the results of these tests the specialists who are specifically trained to read and diagnose treatment based on these tests are known as “radiologist”.

Normally a facility that administers an X-Ray or MRI will then send the films to a radiologist to read. You will typically not see this doctor unless there is some sort of follow-up MRI or X-Ray that needs to be conducted in which the radiologist may need to inject a dye into your system to get a clearer picture of the cause of your pain. However, that doctor will have an important part in your treatment process.

What are Differential Diagnosis and How Does That Help Determine What Caused My Pain?

All doctors will do what is known as a “differential diagnosis”. The first part of that process is to take what is known as a “history of present illness”. The doctor will ask when did this pain start and try to find out whether any occurrences that took place differential diagnosis may be the cause of your pain. Next, they will physically examine you. Third, they will take a medical history which does not mean they will look at every medical record you have incurred in your entire life, they will simply ask you if you have ever had any similar type injuries or pain, did they go away, did they remain, or were they re-occurring.

They are trying to find out if there was anything in your past physical history that may have caused this problem or does your past simply have normal aches and pains that come and go like everyone has. Fourth, and certainly not the last thing that they will look at would be the diagnostic testing – the X-Rays and MRI results.

Once the doctor has all four (4) different portions of the “differential diagnosis” completed they will come up with an opinion of what may have caused the pain that you are suffering. This differential diagnosis can be done by almost any doctor who has experience treating auto injury cases. However, the specific type of doctor who would give this opinion would be a neurologist, orthopedist, doctor with trauma or ER room experience or physiatrist or a nurse practitioner.

As I’ve stated before, it is generally the doctor’s training and experience that will dictate whether they are qualified to give a differential diagnosis in a particular case instead of the area of specialization that they may have. This is due to real life experience and different fellowship as well as the overlap of training areas.

Depending on your injuries, the doctor’s exam, your history, history of present illness and the diagnostic studies, your treating physician may refer you to a surgeon to determine whether you are a surgical candidate. Your treating doctor may suggest you be a candidate for surgery; however your treating doctor if they are not a surgeon, is not qualified to make this determination.

Generally surgeons conduct their own exams, do their own history of present illness, and review the MRI’s and X-Rays themselves. If they are going to do surgery they want to make sure they are not relying on somebody else’s opinion but their own conclusions from test they have conducted and reviewed. Additionally, some surgeons are more conservative than others.

Some surgeons feel that under certain circumstances a surgery is reasonable and medically necessary. Other doctors may review the same test results and suggest the patient wait and still other doctors may simply not want to do the surgery at all. Thus, you may not want to seek one surgeon’s opinion, but more than one surgeon to make a decision on the treatment that is best for you and your specific injuries. We highly stress you get more than one opinion before having any surgery so that you get a range of perspectives and opinions regarding different options.

Surgical Consultations

There are some types of surgeons (i.e.: spinal surgeons) in which the surgeries they perform are complicated and very invasive with serious consequences. Certainly if a doctor is removing a disc and drilling plates and screws into your spine glove, you know it is a very large invasive surgery and the outcome of the surgery still carries significant risks. However there are other types of surgeries, such as arthroscopic procedures to knees and shoulders, that are very common and have a have much fewer risks than neck or back surgery. Advances in medical technology are making it easier for patients to have arthroscopic procedures such as hip and ankle which were not as common 10 or 15 years ago.

After all options have been exhausted a doctor may decide that a patient is a candidate for surgery. However it should be noted that some patients don’t want to have the pain management injections that go along with short term pain management and don’t want to take the risk of becoming chemically dependent. Thus, sometimes the patients will seek surgical advice without first undergoing this type of treatment. Additionally, it should be noted that many surgeons recognize the limitations of short and long term pain management and if the patient continues to have severe symptoms will agree to do surgery on the patient without first undergoing pain management.

Types of Pain Management Doctors’

The different type of doctor or specialist you will need to see will depend on what type of injury you have, where you are in the process and whether or not a doctor feels you may be a surgical candidate. Before a doctor or surgeon is ready to recommend you undergo surgery, they may want you to see a pain management doctor first.

Pain management doctors come in two varieties, short and long term pain management. Short term pain management will typically involve injections of different types of steroids into a part of your body to give the nerves time to heal thus temporarily relieving the pain. This usually only gives relief for 2 or 3 months at a time but can alleviate symptoms permanently in 5 or 6 months if successful. Over time, the body may become resistant to the medications being given and the period of relief will shorten accordingly. Thus, it is more likely that pain management will only work for 4 to 6 months until the patient’s pain returns.

Long term pain medication is highly regulated and discouraged even by many doctors and lawyers as the mass prescription of opiates and other addictive pain medication can have an adverse effect on a client’s life. Your lawyers and your doctors are looking to help their patients/clients not make them worse and are aware that patients can easily become addicted to that medication and negatively affect their lives and injury cases.

After all options have been exhausted a doctor may decide that a patient is a candidate for surgery. However it should be noted that some patients don’t want to have the pain management injections that go along with short term pain management and don’t want to take the risk of becoming chemically dependent. Thus, sometimes the patients will seek surgical advice without first undergoing this type of treatment. Additionally, it should be noted that many surgeons recognize the limitations of short and long term pain management and if the patient continues to have severe symptoms will agree to do surgery on the patient without first undergoing pain management.

This is a decision between you and your doctor and is serious but yet because of the negative consequences of long term pain management and the limited effectiveness of short term pain management, a large number of surgeons may recommend skipping this step all together. There are a number of minimally invasive procedures which the medical protocols do not require or suggest that pain management may be an option prior to having them. This applies not just to knee and shoulder surgery but also to certain types of neck and back surgery.

What Types of Surgeons Should I see for Pain Management?

One of the primary types of surgeons you may see would be a spinal surgeon. Spinal surgeons are usually orthopedic surgeons with an area of 6435805733_914a35fd22 specialization in spinal surgery. What this means is – the spinal surgeon will undergo a fellowship, which is specialized training with other spinal surgeons for a period of time in which they are highly supervised and trained to do neck and back surgeries. There are relatively few of these types of doctors in any particular area and only about 40 or 50 in the state of Florida.

The other type of doctor that will do spinal surgery is a neurosurgeon. However, while there are more neurosurgeons, many of these doctors gravitate more to types of brain surgery and do not specialize in neck or back surgery. Thus, there are a limited number of neurosurgeons that specialize in neck or back procedures.

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