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PCP denies referral to physiatrist

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  • Avatar XX17P 
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    A while back, I inquired to this forum about neck issues my out of state grad school daughter was experiencing.  She has been to extensive physical therapy to no avail. Her primary care doc at the University of North Carolina referred her to sports medicine.  Sports medicine desires a MRI study as did PCP.  The collective wisdom of this forum suggested an evaluation by a physiatrist.  There are several physiatrists in the Chapel Hill, NC area.  My daughter asked the PCP to suggest a specific referral.  While her insurance does not require a referral, we thought her PCP would have a relationship with this type of physician.  The PCP denied helping my daughter as she felt the MRI was the next step ~ period.  Should we just pick a physiatrist from Google?  I would appreciate any advice or ideas that would allow my daughter make an informed choice for this new visit consultation.

    #200634 Reply
    Avatar Tim 
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    I would checkout the med school where she is at.

    #200639 Reply
    Liked by Eye3md
    Avatar Eye3md 
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    Status: Physician
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    If the PCP doc is at UNC, I’d go to a physiatrist at Duke just to aggravate em…….unless the PCP is not into sports, then it won’t matter

    #200671 Reply
    Avatar StarTrekDoc 
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    Status: Physician
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    That’s just weird.   Sports Med tends to have PMR onboard.   Why get a third opinion when MRI is already recommended by two and noninvasive/noradiation?  Save the 3rd person postMRI if you don’t like the initial two opinions on the MRI results.

    2nd the Duke thing 😉   Even outside sports, it’s deeply rooted.

     

    #200678 Reply
    Avatar Tim 
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    Is this the PD for the sports med ortho program?
    Coach K told me to talk with your PMR doc. Doc what’s his name? Mike told me to get an appointment tomorrow. I know it’s Sunday, he said not to weight.

    #200679 Reply
    Avatar HandFellow 
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    Status: Physician
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    The first thing anyone will do with multiple months of failed treatment for neck pain is get an MRI. So just get the MRI.  If you go to PMR, she is going to get a cervical spine injection.  So that isn’t exactly minimally invasive.  It’s better than spine surgery, but it involves needles near the spine.

    I’m not exactly sure what the sports med doc is going to do, but I don’t know why you are doubting the doctor’s judgement so much. Why trust an anonymous board of a variety of doctors over the opinion of the doctor you have chosen.  There was a poster a few months ago asking about a lump on their hand.  The first 10 commenters made their guesses about what it was and they were all wrong.  But yet they gave their opinions willingly.  Get the MRI.

    #200738 Reply
    squaredroot squaredroot 
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    Joined: 07/11/2017

    Fellow Physiatrist here…

     

    Sorry about what’s been going on with your daughter. Have to agree with HandFellow, MRI is the way to go regardless on who orders it.

    MRI results will the dictate wether ESI, different modalities, or Spine/PM&R/Neuro consults are needed. Sportsmed clinics and their opinion along with the PCP should be enough information to base what the next step is.

    Definitely agree with MRI first. EMG/NCS are part of a full HPI / PE and would just warrant a 3rd consult evaluation. EMG/NCS have less specificity that MRI for cervical etiologies as well.

    FYI if she has “failure to conservative measures” (Failed PT, ongoing pain for 12 weeks, paresthesias), MRI is recommended. HPI and PE is always king to determine celerity of diagnostics.

     

     

    "The mass of men lead lives of quiet desperation" - HDT
    laraizcuadrada.com

    #200774 Reply
    Liked by HandFellow
    Avatar Anne 
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    Agree that getting the MRI is a reasonable next step, but someone will need to appropriately correlate the results with the general clinical picture and not just take a small abnormality on the MRI as the cause of the symptoms.  Whether the MRI is unremarkable or has some findings, you still need to appropriately correlate.  This seems obvious, I know, but doesn’t always happen.

    The statement “if you go to PM&R, she is going to get a cervical spine injection” is false, or should be false, unless your physiatrist is a one trick pony.  Would need an MRI anyway before even considering that.

    If she finds herself without clear answers even after the MRI, I think there are some well-regarded outpatient musculoskeletal medicine physiatrists in the PM&R dept at UNC Chapel Hill.

    Good luck to your daughter and I hope she starts to feel better soon!

    #200867 Reply
    Liked by Tim

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