A Personal Philosophy

I am a physician committed to spending the necessary time with patients to:

• Obtain a comprehensive history
• Conduct a thorough examination
• Ensure a proper diagnosis
• Create the most appropriate treatment plan

Whether your pain and other symptoms have an anatomical basis, visible on good radiological studies, or you have “test negative” pain—a painful condition not detectable on X-rays or other studies—or a bit of both, you can never be treated successfully without an accurate diagnosis. As simple and true as this is, too much time, effort, and money (insurance payments, personal funds, and cost of absenteeism) is wasted on wrong diagnoses and inappropriate or totally incorrect treatments. Unfortunately, insurers do not reward physicians with higher reimbursement for correct diagnosis and for offering the treatment(s) designed to maximize the functional capacity of patients. They simply persist in reimbursing for treatments following diagnostic codes allowable under a given contract. In the treatment of pain, patients too often go through this system, bouncing from one physician to another, or from one diagnosis and one treatment to another, all too often without adequate relief. Too many go out on disability, an outcome that could be avoided with proper diagnosis and care.

I practice the kind of medicine of which  I can be proud, enjoying the time I spend with patients, trying to determine what is wrong with them and how best to treat it with the best long-term results. I am tremendously gratified when I hear “you gave me my life back” following a diagnosis that proved challenging to derive, a pain-relieving procedure difficult to perform, or even a novel drug regimen. I derive tremendous pleasure in thinking out of the box—with good results.

You really do not want unnecessary or excessive surgery. You don’t want a surgical fusion to relieve back pain from facets that could be rendered painless by a simple radiofrequency lesioning procedure, as an outpatient, followed by a course of physical therapy, if needed—while you return to work the day following the lesioning. Alternatively, you don’t want useless pain management procedures either—blocks or lesions—to treat horrible sciatica, trying to avoid inevitable disc surgery for an enormous disc herniation. Similarly, sciatica due to pressure on spinal nerves from a tight, unstable spine, requires—sorry to say—decompression and fusion—not facet blocks or epidurals until the cows come home.

What you should want and expect is the simple truth, based on a tremendous clinical experience, widespread knowledge of medicine and medical literature, judgement, and a thorough understanding of you and your problem, derived from spending time with you and analyzing your problem in depth. Yes, a good doctor’s time is not cheap—but if you are fortunate, an excellent consultation should involve money and time well spent—it can “give you your life back,” as patients have said to me after I helped them, and save you from a life of hell or just chronic misery..

For those with a possible surgical problem, an honest first or second opinion by a physician with tremendous experience in assessing anatomically based spinal disorders such as disc herniations, stenosis or narrowing of the spine, spinal instability (spondylolithesis), and synovial cysts, including outstanding ability to read and understand radiological studies—not reports—is imperative. A report is only as good as the radiologist who dictated it, and all physicians have a bad day—or more—and make mistakes. The diagnostic money in the spinal disorders listed above is in the actual films—and to make reviewing them worthwhile, they should be of high quality and several types of studies may be needed to truly understand a patient’s problem.

Many insurance companies will not reimburse for all studies needed or require patients to use radiological facilities accepting specific insurance plans, often with the result of poor images obtained using substandard techniques. Unfortunately in this world plagued by managed care, in which doctors and hospitals are expected to do more with less, increasingly more mistakes are made in establishing true diagnosis and the selection of appropriate treatment. Physicians have not been able to increase their prices in response to increased costs—many of which are due to satisfying government and insurance company regulation as well as malpractice insurance.

All of this is occurring in a period of sky-rocketing premiums and vastly diminishing benefits. Patient’s salaries are flat or reduced. Their bonuses are reduced or gone. Their very jobs may be eliminated next week or month. Their benefits are reduced or completely gone.  Physicians are faced with the same challenges.

The American public has been deceived about healthcare. You get what you pay for—if you are lucky. Paraphrazing what I wrote in my books—if you buy a Volkswagen you certainly will not drive a Rolls Royce. However, if you buy a Rolls Royce you may have purchased a lemon model and regret that you didn’t purchase a cheaper but more reliable car. If you or your insurance pays little for a doctor’s time, and each patient similarly pays little, and the doctor is confronted with ever rising office and personal costs, what do you expect him to do? The correct answer is simply that they spend less time with patients in the office and no time thinking about a complicated case after work. “Going the extra mile” is being killed by the economics of managed care.

As stated above, I go the extra mile and always shall. I run a professional and aesthetically pleasing office in a convenient location. I employ an outstanding, attentive, compassionate, and skilled staff. Most patients are shocked that they usually get a staff member on the phone—not voice mail. If messages are left, they are answered promptly.

My office is unique in that I employ a dedicated patient advocate to fight for maximal reimbursement to my patients from their insurers. Our actions often result in some reimbursement of a claim previously denied, or a significant increase in reimbursement after our appeals.  However, the solution to the reimbursement dilemma, in the foreseeable future, is accepting a bitter realization. The dysfunctional healthcare system—both private and public—can only be circumvented (when needed) by patients willing to spend out of pocket (also if needed) to attain “high quality care” based on the patients definition of  “quality.”  How highly you value your health and well-being is a personal decision.  Increasingly, we must all face and accept this realization. Rest assured, in my practice you will get the best possible care.