being asked by trauma to manage brachial plexus injury

[AndyDufrane]

so I get a call from a local trauma center, level 1, asking if we manage brachial plexus, said yes because there was no EMG done and its been 4 weeks since accident, so patient comes in and states she is here for EMG , has MVAx 4 weeks ago, no LOC, no injury except first rib fx, and on same side as rib fdx, medial forearm paresthesias and posterior arm pain, shoulder MRI and elbow xray unremarkable, so I do EMG, shows brachial plexopathy, patient already been sent to PT by trauma service and put on percs and naproxen, so after I get done with initial visit which was EMG , she goes back to trauma service and they tell patient since I saw the patient I would be responsible for telling patient when she could go back to work and drive, even though per patient she was told she could not drive by trauma service, and she was given work restrictions of 20 hrs by trauma service PA or NP, so I am confused, I saw the follow up patient and only addressed the pain apect of her brachial plexus injury w/ membrance stabilising agent, am I also to address these other items too such as driving and RTW,

---

Members don't see this ad.

 

[deleted472101]

They asked if you managed brachial plexus injury, I think all those things come with that. Maybe they were not specific. it was a trauma service, I think you would do a much better job at it than them.

 

[Disciple]

so I get a call from a local trauma center, level 1, asking if we manage brachial plexus, said yes because there was no EMG done and its been 4 weeks since accident, so patient comes in and states she is here for EMG , has MVAx 4 weeks ago, no LOC, no injury except first rib fx, and on same side as rib fdx, medial forearm paresthesias and posterior arm pain, shoulder MRI and elbow xray unremarkable, so I do EMG, shows brachial plexopathy, patient already been sent to PT by trauma service and put on percs and naproxen, so after I get done with initial visit which was EMG , she goes back to trauma service and they tell patient since I saw the patient I would be responsible for telling patient when she could go back to work and drive, even though per patient she was told she could not drive by trauma service, and she was given work restrictions of 20 hrs by trauma service PA or NP, so I am confused, I saw the follow up patient and only addressed the pain apect of her brachial plexus injury w/ membrance stabilising agent, am I also to address these other items too such as driving and RTW,

You didn't know this is what's expected of a PMR or "pain clinic".

I get this all the time from the less than ideal referral sources, i.e. while you're handling the pain issue, please take over everything related to DME, filling out forms, etc.

 

[AndyDufrane]

You didn't know this is what's expected of a PMR or "pain clinic".

I get this all the time from the less than ideal referral sources, i.e. while you're handling the pain issue, please take over everything related to DME, filling out forms, etc.

lesson learned, she is a social case, losing her house in couple of weeks, about to lose job, etc.

 

[specepic]

Add to the lessons I learned in my first 1-2 yrs of practice

Worst referral sources:

1. worst referral source is your competition (PMR or Pain). It is a dump until proven otherwise. Usually an opioid dump

2. Referral from spine surgery when they have their own PMR/injection guys. Also a dump. They either did the surg and/or inj's already and porb started the opioids

3. non-local PCPs.

4. self referred (trying the opioid lottery or poss just plan 'ol B.S.C.)

5. Surgery services

 

[AndyDufrane]

Add to the lessons I learned in my first 1-2 yrs of practice

Worst referral sources:

1. worst referral source is your competition (PMR or Pain). It is a dump until proven otherwise. Usually an opioid dump

2. Referral from spine surgery when they have their own PMR/injection guys. Also a dump. They either did the surg and/or inj's already and porb started the opioids

3. non-local PCPs.

4. self referred (trying the opioid lottery or poss just plan 'ol B.S.C.)

5. Surgery services

much obliged, I don't know what it is about physiatry that sends the signal to other specialties, "please, dump your difficult, chronic opioid patients on me when your done with your procedures".

 

[bedrock]

much obliged, I don't know what it is about physiatry that sends the signal to other specialties, "please, dump your difficult, chronic opioid patients on me when your done with your procedures".

A few reasons.

1-Pain docs learn to only accept referrals from good sources, because there is so much psych in pain.
2-PMR residencies are much more about, we'll take care of it as long as it doesn't need surgery......
3-Many interventional pain docs label themselves as interventional only so if they can't do procedures, they dump. Same with surgeons. If they can't cut, then they don't want to see them.