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A Brilliant Mind

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It’s kind of an inside joke around our office that I’ve been called “brilliant” by a physician for my interpretation of a lumbar MRI.  This story happened several years ago when Stacy Mathis, RN working with me in training, and was my witness!  This physician is known for his eccentric personality, and he went all out to make me feel as though my critical thinking skills really were brilliant!

 I was attending a clinic visit for MMI and PPI assignment of a shoulder and lumbar injury.  The shoulder had been complicated by a postoperative infection, and was now healed.  The lumbar injury had been diagnosed as a strain, although an MRI had been obtained to rule out a disc herniation.  I was expecting a high rating on the shoulder, as the IW did have limited ROM that was permanent.  I was not sure how the physician would approach the disc bulge.   I had done my homework to review the medical file prior to the visit so that I could knowledgeably converse with the physician during the visit.

In the exam room, I could tell this physician was looking to assign additional impairment for the lumbar injury, with a left sided disc bulge revealed on MRI.   I called the physician’s attention to the fact that the IW’s complaints had always been on the right side, which did not correlate with the MRI finding, and therefore questioned how he was certain – without a pre injury MRI for comparison, that the left sided disc bulge were attributed to the work injury.  


The next 10 minutes were very entertaining.  The IW was in her late 50’s, and therefore likely had normal degenerative disc bulges.  He looked through the chart and clinic notes.  The physician agreed with my reasoning and told the IW and my coworker, Stacy, that the general practitioners in his town couldn't interpret a MRI with such logic!  Seriously?  I’m sure the IW was amused – although she was quite accustomed to this MD’s personality.  The physician opined that in the absence of any correlating symptoms or evidence of acute injury(on MRI) with the left sided disc bulge, her PPI for the lumbar spine was 0%.  


The greatest takeaway from this story is the opportunity the CM had to interface with a physician before MMI/PPI was assigned and dictated.  It's not that it was a brilliant deduction, really, but the fact that I was present with the IW and MD when this was being addressed, and I knew the impairment should only be
based on the objective findings as related to the injury.  It's what we do.  The conversation took place right in front of the IW, and she was fine with the outcome.  The IW is much less likely to feel confident that her 0% PPI was correct if the MD had errantly assigned 5% to the body whole, and then after correspondence reversed  it to 0%.  Worth the cost of a case manager?  I'd say so.  The second greatest takeaway, of course, is that I’m brilliant! 
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