| So what happens when you have been injured on the job and are not getting better? If your injury is not getting better in a timely fashion it may be time for a referral to a specialist. Most primary or gatekeeper doctors of record for your work injury focus on urgent care or initial care. This may include simple diagnostics such as exam and x-ray followed by medication and therapy. However what do you do when it is not enough or it doesn’t work? One of the unfortunate things about worker’s compensation injuries is that there are a significant amount of rules and regulations for the doctors to comply with that is not always consistent with a traditional model of medicine regarding when to consider specialist or specialty diagnostic testing. Previously there was basically an unlimited amount of therapy afforded patients provided that progress could be demonstrated. Then in 2005 with the implementation of the Official Disability Guidelines, There were major changes which effectively limited the amount of therapy an injured worker can receive regardless of progress. The changes in guidelines also changed the ability to order diagnostic testing. Previously there was a 6 week wait for example prior to the ability to order an MRI, which was always considered opposite to clinical evidence. Now, there is no wait for additional imaging studies, although some doctors continue to practice under the old rules. With the ability to order imaging earlier also allows for a more accurate diagnosis and allows for referrals to specialists sooner. This becomes very important when understanding that most therapy is only afforded for about 4 weeks regardless of the diagnosis. What does all this mean for you? Well it means that years ago you would have had much longer to get all the treatment you may need. Today however with only about a month of therapy afforded to most patients the role of expedited imaging and referrals to specialists become even more important. The bottom line is that as a patient and as an injured worker, you and your employer have a right to know what is wrong with you and how long it can be expected to recover. Most injuries are initially diagnosed as a sprain or strain injury. It is the role and obligation of your doctor to order any and all diagnostic tests necessary in a timely fashion in order to make sure there is no other injury involved, especially if your pain and other symptoms are continuing. Pain or numbness down the legs or arms or one sided weakness to the arms, hands, legs or feet are classic signs that there is potentially more wrong. The sooner diagnostics are ordered, the sooner a specialist can be referred to in order to evaluate the need for other treatment options which may include injections or even surgery. Specialist will normally not accept a patient directly as the doctor of record under worker’s compensation but rather by way of referral only. Therefore, communicate with your doctor to ensure he or she knows if you are progressing. If therapy and medication is not helping it may be time for a specialist referral. |
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