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Dr. Corenman,
This topic post relates to entry # 2548 of 3 weeks ago, found under my prior question regarding “Discrepancies in MRI / Foraminal Stenosis”… In the last 3-4 paragraphs of that post, I mentioned an appointment with a 2nd surgeon, to whom I’d been referred for evaluation of severe foraminal stenosis bilaterally at L2/3. In reviewing that portion of my post, it’s not difficult to discern that surgeon #2 was less-than-empathetic, and displayed a demeanor and overall bedside manner bordering on verbally aggressive, arrogant, and condescending. A family member of mine, a retired nursing instructor and RN administrator, accompanied me on that visit, which seems now to be a very fortunate occurrence.
About a week ago, I requested that surgeon’s dictated clinical notes from my visit with him. The notes were faxed to me promptly, and I was shocked and angered at what I read. I’ve counted no fewer than 9 statements / observations by this surgeon that are either absolutely false, or simply did not occur during the visit. I’ve also made note of several “neurological tests” he noted as having conducted, yet these “tests” were either feigned, or were never performed on me. A few examples are:
1. “Pt has downward going toes on Babinski”: HE NEVER PERFORMED A BABINSKI TEST ON ME, BECAUSE HE NEVER ASKED THAT I REMOVE MY BOOTS & SOCKS.
2. “Pt has warm, well-perfused bilateral lower extremities: HE NEVER LOOKED AT MY LEGS, FELT MY LEGS, NOR DID HE REQUEST I REMOVE MY BLUE JEANS AND BOOTS AND PUT ON AN EXAM GOWN.
3. “Pt has a normal heel-to-toe reciprocal gait, although she walks with a cane for balance”: DR. CORENMAN, HE NEVER SAW ME WALK, NOR REQUESTED I WALK TO ASSESS MY GAIT. I WAS SITTING DOWN THE ENTIRE APPOINTMENT, AND THE CANE HE NOTICED WAS LEANED AGAINST THE WALL. HE NEVER INQUIRED AS TO WHETHER I USE IT FOR BALANCE, TO ALLEVIATE PAIN IN MY RIGHT LEG, OR TO ASSAULT PEOPLE.
4. “Sensation is grossly intact to light touch”: IN STAR WARS, I BELIEVE I SAW LUKE SKYWALKER ASSESS HOW SOMEONE RESPONDED TO TOUCH FROM ACROSS THE ROOM, BUT OTHERWISE, I DON’T THINK DOCTORS CAN YET DO THIS.
5. “Isolated motor examination of bilateral lower extremities reveal 5/5 EHL, gastrocsoleus complex, tibialis anterior, and knee extension”: THE ONLY ONE OF THESE HE ACTUALLY PERFORMED WAS THE KNEE EXTENSION. AGAIN, I WAS WEARING COWBOY BOOTS, SO MY BIG TOE WAS IN HIDING AT THE TIME. HE NEVER TESTED THE REST OF THESE.
6. “Pt has +1 patellar and +1 Achilles reflex that are symmetrical”: HE GRABBED HIS LITTLE RED HAMMER AND HIT THE SIDE OF MY COWBOY BOOT ONCE ON EACH LEG, THEN HIT THE BACK OF THE HEEL OF MY BOOT ONCE. DON’T MEDICAL STUDENTS GET AN “F” ON ‘REFLEX QUIZ DAY’ IF THEY PULL SOMETHING LIKE THIS DURING CLINICAL ROUNDS?
7. There are numerous other outright untruths in my actual notes from the visit, however the one that struck me as egregiously unethical was his notation that he, “Strongly recommended the patient wean herself off of all narcotics.” DR. CORENMAN, THIS COMMENT IS COMPLETELY FALSE. HE NEVER DISCUSSED MY PAIN MANAGEMENT MEDICATIONS WITH ME, NOR DID HE EVER ONCE ASK ME WHAT PHARMACOLOGICAL MODALITIES I WAS CURRENTLY EMPLOYING. MY FAMILY MEMBER IN THE ROOM CAN ALSO ATTEST TO THE FACT THAT HE NEVER MADE THIS STATEMENT.
MY QUESTION(s) TO YOU AS A PHYSICIAN / SURGEON, WHO IS BOUND BY THE MEDICAL PRACTICE ACT:
1. These numerous false statements and untruths regarding neurological exams are now in my permanent medical file. Should another physician review these in terms of my ongoing treatment plan, he or she could be easily mislead or be reading false findings altogether, correct? This is potentially putting me at risk.
2. Why would a surgeon behave in this manner? And, given he only completed his residency 2 years ago, what does a young surgeon gain from treating a patient in this manner? Why would he simply lie about performing basic neurological tests while investigating a back problem?
3. His notation “recommending the patient wean off of narcotic pain medications” clearly insinuates that the patient “doesn’t need these medications”, or is perhaps “exaggerating symptoms or malingering.” I was stunned when I saw that notation in his visit report. Given my 30-year history of complicated spinal surgeries and degenerative joint disease, and my well-documented, fastidiously recorded pain management regimine, I consider such a comment libelous and harmful to my status as a responsible, legitimate patient.
What are my options regarding an amendment of these visit notes? Do i have legal recourse? And, I’m currently drafting a letter of complaint, to be addressed to the Chief of Orthopedics, as well as the State Medical Board. This surgeon is also affiliated with the medical school there. As such, he’s listed as an assistant professor of orthopedics. I highly doubt he instructs his medical students on their clinical rounds that reflexes should be tested while patients are wearing full body armor and big boots. Or, that it’s permissible to just falsely indicate on a patient’s chart that reflexes were checked, when they really weren’t.
This is my LIFE he’s toying around with, and his flippant assessment of my condition has me angered beyond belief. His actions clearly tell me he didn’t care, and he presumed I wouldn’t take notice of his incorrect techniques, or his outright lack of interest in investigating my symptoms further after a questionable MRI image.
Your thoughts on this matter?
I unfortunately cannot answer for other doctors. Your experience was poor and the dictated information was obviously incorrect. I would send a letter to this physician delineating the misinformation and look to his response. Contacting his supervisor would be appropriate.
Dr. Corenman
PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.I had a VERY similar experience although the spine surgeon in question is well established and possessed reasonably nice “bedside manner”. He performed NO physical exam. He stood in front of the computer screen and I sat in a chair, fully clothed, probably 8 feet away. He commented on an MRI of my T-spine. (Perhaps, I shouldn’t have let him see it!) I was complaining of neck pain.
I did not have any recent cervical spine imaging. The nurse required me to have office X-rays of the neck BEFORE I saw the doctor for the first time. (Axial views were not obtained, incidentally.)
I asked for a “report” on the C-spine film (for my records) which I think the surgeon is required to record if he is billing for both the technical and professional component of office x-rays. (Incidentally I was charged $15 for a CD of my X-ray.) I was provided with the “notes” from my visit. Reflexes, strength, ROM were graded. Babiniski and Lhermitte were negative, etc. All signs were reported to be negative or normal. He did note one positive “finding”…slight pain on rotation. In the history, he did get as far as “chief complaint”. I had told him that it hurts to turn my head and that I couldn’t turn it very far.
Over two decades ago, I sustained a C7 anterior vertebral body fracture landing short…very short…on a back flip. Over the years, I have been told this is a “typical” injury. During the visit I told the surgeon about this and he quickly pointed to the X-ray and said…there it is. In the notes he recorded this as “C7 spinous process fracture’. My FP and I were curious about this so she sent me to an “imaging center”. I wrote the radiologist a letter explaining the injury, my FP’s concern (about chiropractors!) and asking for a comment on C7. We got the comment. In all fairness, the changes are subtle…my chiropractor told me that it is the stuff that chiropractors always see but radiologists may miss if not pushed. Maybe it is OK if the surgeon missed a somewhat subtle change in shape of a vertebral body after so many years of bone reformation. However, he reported an old spinous process fracture…which never existed.
But THIS is what really got to me! I had previously seen a PM&R who works in the same office for evaluation of a large thoracic disc herniation and corresponding radiculopathy. (I do have a thread going on this and I am ever grateful for your help!) I chose a PM&R at that time because a couple spine surgeons who had seen my MRI (though not me) said injection was my best bet. The PM&R had highly discouraged me from injection. He told me that this would be pushing me one step closer to surgery…silly logic. (Interestingly, the PM&R also told me that “these problems are very easy to fix…small operation”.) Anyway, the spine surgeon recorded in his notes that I had refused injection to the thoracic spine during an appointment with his PM&R colleague six months earlier. The reason I saw the PM&R was to get a referral for injection!
I did see the surgeon once more to review the results of a C-spine MRI that probably wasn’t indicated in the first place. (This group owns an MRI.) I did “confront” him about the injection comment and set the record straight. He told me that I need to understand that transcription errors occur. He did not offer to amend his comments. I did not mention his comments about C7 fracture. I don’t think this is my place. I did though send him the detailed report I obtained from a radiologist about the changes at C7 which the radiologist stated were consistent with vertebral body fracture and the mechanism of injury. As for the fabricated physical exam, I did not say anything. However, I think he practices in a field where there is some likelihood of limitation after surgery… some real “exposure”. I think it would have been in HIS best interest to perform a thorough physical exam and carefully document any “preexisting” limitations.
What clinic are you mentioning?
Please be more especificDear Maquingo:
To whom are you addressing your reply? I am not inclined to post the name of surgeon in question in a public forum, especially as I have provided a fair bit of clinical detail. I am curious as to why you are seeking this information. If this forum has messaging capability, you are welcome to send me a private message.
Hart
I, too, am hesitant to reveal the name of the practice or my surgeon here, if only out of professional courtesy and ethics.
S.W., NC
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