Define "Mindless Block Jock"

[emd123]

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Please, define "Mindless Block Jock":_____________________

 

[101N]

Please, define "Mindless Block Jock":_____________________

Background?

 

[Taus]

Leg pain--> series of 3 esi at level w biggest bulge on MRI (no real history/physical/other good conservative care required)
Back pain--> facets x 3
Repeat as frequently and for as many times as insurance will allow
Follow with stim trial (that fails, but pays well)
D/c from practice as nothing else to offer

Only a pgy4 resident but have already seen the above more often than appropriate individualized care

 

[Ducttape]

Transforaminal q2mo x3... 2 levels each side (i.e. 4 TF for bilat radic pain).

After the 3 shots, refer to surgery partner for fusion.

 

[Aether2000]

* Q2week TFESI x 3 without any positive patient response
* Scheduled series of 3 of anything
* 30-40 procedures per day....makes it impossible to have enough time to do anything except stick needles into people
* High dose steroids stacked on top of high dose steroids resulting in severe patient complications
* Failure to consider alternative pathologies: ie. everything comes from the spine
* Treating only with needles....no other therapies used

These are starters

 

[Jcm800]

Me.

 

[lobelsteve]

Needle jockey: Anyone injecting more than I do.
Pill pusher: Anyone injecting less than I do.

 

[Ducttape]

Needle jockey: Anyone injecting more than I do.
Pill pusher: Anyone injecting less than I do.

fixed it.😉

 

[Aether2000]

lol...too funny. It is all a matter of perspective....based on our pain practice model and how we get our referrals.

 

[PinchandBurn]

i love it. evryone on here thinks their the best and that everyone else is 'bad' or a mindless 'jock'. The reality is , it's somewhere in between.

 

[emd123]

Here's my definition:

I had a patient come to me recently. A 90 year old with axial low back pain. In the previous 6 months, she had every single injection done to her spine that can be done (all in a series without any improvement) and then some. TFs, multiple ESIs, SIJs, MBB, RFs, caudal, sacrococcygeal, you name it. Not one bit of improvement. The only thing not done was stim, because she flat out refused. After beating the piñata until he could get no more candy to come out, he kicked her to the street.

I actually sat down and talked to the patient and asked, "Of all the things that have been tried, what's worked the best?"

Her answer, "My Tylenol that I take twice per day."

I increased her Tylenol and she came back in a month, thanked me and said she never felt better.

 

[Aether2000]

Priceless!!

 

[Jcm800]

im sure you are having her come in for monthly visits to get tylenol refills, to check her liver enzymes and to drug screen her every month to make sure she is taking that tylenol, right?

Here's my definition:

I had a patient come to me recently. A 90 year old with axial low back pain. In the previous 6 months, she had every single injection done to her spine that can be done (all in a series without any improvement) and then some. TFs, multiple ESIs, SIJs, MBB, RFs, caudal, sacrococcygeal, you name it. Not one bit of improvement. The only thing not done was stim, because she flat out refused. After beating the piñata until he could get no more candy to come out, he kicked her to the street.

I actually sat down and talked to the patient and asked, "Of all the things that have been tried, what's worked the best?"

Her answer, "My Tylenol that I take twice per day."

I increased her Tylenol and she came back in a month, thanked me and said she never felt better.

 

[Tenesma]

mindless block jock?

1) series of 3 of anything
2) an algorithm that goes as follows: ESIx3, SIx3, FJIx3, RF bil, Troch bursa, Stim trial - regardless of pain complaints
3) consultations done by an NP who recommends #2 (above) be done by the jock

surprisingly I have seen some spine surgeons do the above...

 

[hyperalgesia]

What you guys are describing is a lot worse than what I think of as a mindless block jock. What you guys are describing is almost criminal and is certainly malpractice. These procedures are NOT indicated. It's like taking gall bladders out for all abdominal pains..

To me a mindless block jock is just someone who does what he is told to do. Maybe he just does procedures assigned to him by a NS. I don't think he's necessarily going to hell for this.

 

[Tenesma]

ok - fair enough - add "mindlessly performs procedures without performing an adequate history, exam, review of imaging - instead relies on "super-brilliant" spine surgeons to figure things out"

 

[Circuitous]

Firstly, I think it's fair to say that traditionally the term "block jock," and its pseudonym "needle jockey," is used primarily as a disparaging term. The scornful rhetoric tends to find its origin in A) the financial ramifications of interventionally oriented care, and B) the all too common practice of discharging patients from one's clinic when such approaches have both been exhausted and failed to provide clinical improvement. Personally I've made my peace with the cosmos over the pecuniary implications of practicing multidisciplinary pain medicine, but the abject disregard for the Hippocratic Oath continues to boil my blood.

In this manner a "block jock" is someone that instigates care based on presumed reimbursement rather than clinical indication. If you genuinely believe that a "series of 3" anything is indicated, and are performing the procedures based on your best clinical judgment, you're not the prototypical needle happy practitioner that tends to engender scorn from colleagues. Some training programs are far more interventionally focused than others, so it stands to reason that some physicians will be more inclined to choose an interventional approach to patient care. But if you feel copious myofascial hypertonicity in the lumbar paraspinals and have a totally clean, or totally discordant, MRI but recommend a litany of procedures nonetheless then the moniker probably fits.

 

[lobelsteve]

Firstly, I think it's fair to say that traditionally the term "block jock," and its pseudonym "needle jockey," is used primarily as a disparaging term. The scornful rhetoric tends to find its origin in A) the financial ramifications of interventionally oriented care, and B) the all too common practice of discharging patients from one's clinic when such approaches have both been exhausted and failed to provide clinical improvement. Personally I've made my peace with the cosmos over the pecuniary implications of practicing multidisciplinary pain medicine, but the abject disregard for the Hippocratic Oath continues to boil my blood.

In this manner a "block jock" is someone that instigates care based on presumed reimbursement rather than clinical indication. If you genuinely believe that a "series of 3" anything is indicated, and are performing the procedures based on your best clinical judgment, you're not the prototypical needle happy practitioner that tends to engender scorn from colleagues. Some training programs are far more interventionally focused than others, so it stands to reason that some physicians will be more inclined to choose an interventional approach to patient care. But if you feel copious myofascial hypertonicity in the lumbar paraspinals and have a totally clean, or totally discordant, MRI but recommend a litany of procedures nonetheless then the moniker probably fits.

Welcome aboard, but put down the damn thesaurus, I cannot understand any of that stuff. But I do agree with it.

 

[emd123]

im sure you are having her come in for monthly visits to get tylenol refills, to check her liver enzymes and to drug screen her every month to make sure she is taking that tylenol, right?

No. Discharged her. Found out she robbed a liquor store and took all their Tylenol and denture glue.











LOL

Just kidding