Mythology of Personal Injury: Gap in Care

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All too often I have gotten a call from an attorney hoping that I could help salvage a case. The most common problem they face is a gap in care. Any extended period without documented treatment creates the impression that there was no need for treatment.

The most common problem that I see here is when the patient was involved in a crash and a month or so later calls the attorney. A 4 to 6-week gap in care dating back to the motor vehicle collision can, on the surface seem to be nothing short of an up-hill battle. Usually however, this is the least challenging of all gaps.


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My first question to this distressed attorney is, “Did they go to the ER?” The answer is usually, “yes.”

My second question is, “Was there a prescription for pain medication and muscle relaxers.” Again, the answer is usually, “yes.”

While this may seem like a gap in care and an insurance adjuster may try to go with that excuse, clearly there is no gap. It is rare for a crash victim to end up in the ER with complaints and not be sent home with a 30-day supply of medication. Usually that comes with instructions to see their family doctor or a specialist. Sometimes with a younger more enlightened emergency department doctor the instruction would include seeing a chiropractor.
This patient does not have a gap in care. In fact, they have been very closely following the ER doctors’ instructions to take medication for 30 days. At five weeks, when they have run out of medication and their pain is no longer suppressed, they need your support.


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The other situations that are very common in personal injury cases fall into two categories. First, all those patients who have a life scheduled and do their best to maintain their scheduled visits to the doctors. This is commonly seen as work schedules that make it more difficult to get to that chiropractor’s office as often as they would like to or should.

This is also seen where they have a long-planned trip, shortly after they have been injured in a crash. These patients are often in a position where such a trip cannot be canceled, or if so, would be done at great expense.
In both of these cases where following through on passive care in the doctor’s office is too much of a challenge, all that needs to be done is for the doctor to prescribe active care. Active care is defined as what the patient is doing on their own as compared to passive care that is administered in the doctor’s office.

I have seen these cases where the patient had plans to spend a month on the beach. They were given instructions to lay their blanket on the hot sand and lay there for 30 minutes at a time to absorb the heat into their muscles. Heat packs in an office are a common therapy. Heat from the sand on the beach is just as valid in helping to facilitate the healing process.

These patients have also advised to get in the water. They do not need to be Olympic swimmers. All they need to do is get into the water and move around. Walking with resistance is good exercise. Balancing oneself in the water with shifting currents from the tides will also provide exercise for just about every muscle group and will do so without gravity or impact. This can also facilitate recovery from concussion related problems. All of these are valid active care.


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The second group of patients with a gap in care are the ones who can be more troubling for a PI case. This is the patient who simply does not follow through on the doctors’ schedule or instructions. Any doctor who is familiar with motor vehicle injuries will spend time teaching the patient things they can do at home to facilitate the healing process.

When a chiropractor has recommended an initial schedule of three times a week the next four weeks and the patient shows up one time a week, they are effectively telling everyone the problem is not that bad. If active therapies have been taught and the doctor documented that the patient is following through, then there is no gap. Then scheduling conflicts will have been explained away.

Patient care, be that in a chiropractic office or in a surgical procedure, are an important part of your client’s care. When the patient has been educated on exercises and procedures that can be performed at home and it is documented that they have reported following the doctor’s instructions then the gap in care is more of a myth than a reality.

Dr. Bill Gallagher

Dr. Bill Gallagher, DC, CMVI teaches personal injury classes through the American Academy of Motor Vehicle Injuries. He can be reached at [email protected] or (480) 664-6644.

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