Choice of Physician – Right & Responsibility

One of the most critical rights an injured worker has in Washington State’s workers compensation is the right to choose the medical provider who will treat the industrial injury or occupational disease.  Imagine if you could only treat with the ‘company doctor’. Would that medical provider be looking out for your health and welfare, or would the provider be more interested in shielding the employer, or minimizing the injury?  The answer is so obvious it is not really worth debating.

 

So, this entry is not about why the right is important, that is a given. All rights come with responsibilities. The right to choose your medical provider when you have a work injury is no different.  As the person who is injured you have the right to choose your medical provider, you also have the responsibility to choose a qualified provider. While you may have a primary care provider who you consider your ‘regular’ doctor, that person may not necessarily be the best qualified specialists to deal with your particular injury or disease.  It is your responsibility to get to the right medical provider. 

 

You might need an orthopedic specialist if you have a low back or neck injury. You might need a podiatrist if you have a foot or ankle problem.  A chiropractor may be best to evaluate and treat a strain or subluxation, but if you have neurological symptoms you may need a consultation with a neurologist.  To further confuse the issue, there are specialties within specialties. An orthopedic specialists who primarily treats the spine, might be a lousy choose for a hand or arm injury, and visa versa. The type of medical provider you need may evolve over the life of your claim.  If you initially treated with an orthopedic surgeon, post surgery you may be better served by a Physiatrist who specializes in rehabilitation and physical medicine.

 

The point here is not to scare you with the wild and confusing world which is the medical profession. The point is to encourage you to open your eyes and be proactive with your medical treatment, beginning with your choice of physician. How to start? Well, you initially reported your injury to a medical provider.  In Washington an L&I claim is started with an application for benefits completed in part by a medical provider.  Ask questions of that provider, whether it was your ‘regular’ doctor or an emergency room physician. Ask what kinds of physicians evaluate and treat the type of condition or injury you have. Ask for names or referrals. Write it down and follow up.

 

What if the initial physician who evaluated you doesn’t know yet what your diagnoses is? Often additional tests or studies are necessary before you can get an understandable diagnoses and responsibly choose an attending medical provider. That’s ok. Follow up as instructed by the provider who is ordering the tests. When you do have a diagnoses, then ask about the type of specialists you should be seeing. 

 

What if over the course of your treatment the type of medical provider best suited to treat your injury changes? No problem.  You can change your attending medical provider by simply notifying your claims manager. What if it turns out you just simply don’t care for the physician who is treating you? Again, no problem. Find a medical provider you are more comfortable with, and notify your claims manager of the change. Be aware of “doctor shopping”- a phrase thrown about to describe the patient who bounces from doctor to doctor. You may have a legitimate reason for changing physicians, if so you shouldn’t hesitate. However, beware of changing doctors repeatedly because you aren’t getting the answer you want. Physicians can only give you their best answer, it might not be the one you want.

  

Which brings me to part two of your responsibility with respect to medical treatment. Follow-up. It is so easy in a busy physicians office to get dropped through the cracks. You had your MRI and the office was suppose to call you to schedule a follow-up appointment but you haven’t heard anything yet? Call and ask to schedule an appointment. You’re given a referral for physical therapy? Please call and schedule the initial appointment. It seems like your are not getting any better? Ask what’s next or what other treatment options are available. You have a responsibility to get the treatment you need for your work injury. Sadly, no one is going to walk you through this part of the maze. The good news is most medical providers, be they orthopedists, neurologists, physiatrists, physical therapist,  chiropractors, podiatrist or psychiatrists are genuinely nice people who are interested in getting you better and back on your feet. If you ask, they’ll get you an answer. They want to help, let them.

  

It is safe to say there is nothing in the workers compensation world which has more rules, regulations and policies than medical treatment for work related injuries or diseases. It is a huge cost driver of the entire system. I expect there will be a number of posts on this blog about medical issues. For instance, what types of treatment are allowed; what requires pre-authorization; issues surrounding pain medication; what to do if treatment is denied; treatment for conditions not allowed on your claim which are retarding recovery; the department’s responsibilities; the medical provider’s responsibilities, the list is almost endless. So, for now, take away this thought. You have the right to choose your attending medical provider. Don’t squander that right, choose responsibly.

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