Puziss Orthopedic Referrals

[Guest guest]

I just got off the phone with Puziss office, and was told that for months he was completely unaware (and rather loudly angry when he found out) that one of his office workers had been telling chiropractic physicians, patients, and attorneys that he would not take mva and chiropractic referrals even if the referral was made early on (when PIP benefits were still amply available), and that he would only take patients, regardless of cause, if the patient produced proof of current private health insurance before even scheduling the appointment. That was incorrect, and his office would like to correct that.

I know that many of you expressed some understandable dismay after trying unsuccessfully to refer patients to him in need of orthopedic consultation. I know that when I heard that he wasn't taking referrals, I personally called his office and spoke with the "gatekeeper" and was also told in no uncertain terms that regardless of what Dr. Puziss may have said when he spoke at the 2007 CAO Convention or elsewhere, he wasn't taking mva referrals, period, end of story. Dr. Puziss was apparently unaware that his scope of practice had been limited by his staff. He is accepting and will welcome your referrals.

So, I again throw Dr. Puziss name out there to all for consideration for orthopedic consults, second opinions, etc. He is a very good Board Certified orthopedist, and while he was known for years as the go-to guy when all else failed with shoulder injuries (I had patients with frozen shoulder and botched surgeries routinely drive up to Portland to get fixed by him from Coos Bay, Eugene, and elsewhere), he is also a very capable general orthopedist for neck/back, knees, etc. Do to personal medical reasons, he apparently is no longer doing surgeries, so if a patient ultimately needs surgicial intervention, he will refer them on and grease the path with other surgeons in Portland.

I know that some of you also expressed some concern that in years past, whenever you referred a patient to him, the patient seemed to disappear and ended up doing physical therapy with Bonino or elsewhere and the patient tended to not find their way back to your clinic. Dr. Puziss has assured me (and all the doctors he spoke to at the CAO Convention) that regardless of whether that was a right or wrong perception in the past, that you need not worry about that at this time or into the future. He is well aware that Chiropractic Physicians are licensed to perform physical therapy.

Now that doesn't mean that he will necessarily automatically refer the patient back for ongoing multi-weekly chiropractic treatments, if that is not what he believes the patient needs. While he is and will be supportive of chiropractic, he will of course be exercising his own independent medical judgment about what the patient's needs are. He may send the patient back with specific treatment recommendations, he may concur in your treatment plan, or he may recommend a new approach in a case that appears to have plateaued. Also, with respect to insurance, you've heard me ad-nauseum stress the importance of making early referrals in personal injury cases. If I were a neurologist, orthopedist, neurosurgeon, or other specialist, at some point I would certainly tire of only seeing patients from certain chiropractic clinics after IME cut-offs, after 10 months and $ 15,000 worth of chiropractic treatment had been paid by the PIP carrier, etc. A compassionate person's willingness to engage in pro-bono "maybe I'll get paid a year from now, maybe I won't" services has understandable limits. Also, most board certified medical specialists are fairly intelligent: they know when someone is asking them to be a rubber stamp.

I would also think that if I were going to make a referral, I'd forward to the specialist actual MRI films and reports, xray films and reports, enough of the chart to show the doctor where the patient's care has been and where it's going well in advance of the appointment. I probably would even call his/her office to confirm/inquire what they wanted sent prior to the appointment. I've seen many cases where an appointment is set three weeks out, and when the patient shows up, the specialist has to rely solely on the patients verbal history, and a thorough evaluation of the case cannot be made right then and there, because the specialist needs to order the films and reports that have already been done or order his/her own. So then the specialist has to set another appointment out another 3-4 weeks so he/she can review that which could have been made available on day 1.

In listening to some of Tyrone Wei's presentations (and frankly I think is among the best of the best radiologists in this state--medical or otherwise), it seems that with the increased accessibility and usefulness of MRI films, the clinically accepted trend is to request such studies in more, as opposed to less, cases. Even if there's not a blown disk or severed rotator cuff requiring surgery, those films document a whole bunch of stuff about what is going on in a joint, evidence of edema and high signal intensity will be documented (at least if Tyrone is reading the films), and even pre-existing degenerative conditions can go a long ways toward explaining why a particular individual patient is not recovering as fast as American Family Insurance would like. Those conditions are not visualized as well on plain films. As a lawyer, I don't think I've ever seen an MRI report that did not in some way help a client's case and help get outstanding medical bills paid (help that exceeds the cost of the MRI).

Also, I've heard from several specialists (and Dr. Puziss is one of them) who indicate that many times they take chiropractic referrals and when the patient comes in, the specialist is not really sure why the patient has been referred, and the specialist doesn't have a clear concise picture of where the patient has been or where their treatment is heading. Many times the specialist doesn't even know precisely who made the referral, and they are completely unaware that the referral was made by the treating chirpractic physician (you). I notice that when an M.D. general practitioner (and certainly when many of you) make referrals, an introductory letter is almost always sent to the specialist explaining the reason for the referral and some of the specific concerns and questions the referring doctor has. It seems in almost every case, the specialist sends a nice letter back to the referring doctor thanking for the referral and explaining the specialist's findings and recommendations. As a trial lawyer, those inter-profession letters are dynamite, and are worth much more than most closing narrative reports (heck, they usually make the time and expense of a closing narrative report unnecessary). If I were a treating physician, I would think those types of introductory letters would also go along ways toward building my own individual credibility and rapore with the medical specialist.

Anyway, back to Puziss. I would encourage you to consider him when making orthopedic referrals. He's worth the drive.

Best Regards, G. , Gatti, Gatti, et. al.