Our vision of Spine & Joint Wellness...
- We believe in treating you, the patient, not the MRI
- We believe that your initial evaluation is best performed by a physician specializing in Rehabilitation Medicine, who is trained and experienced in the care of disorders of muscles, joints, and nerves
- We believe that a formal treatment plan should be created after you have been evaluated
- We believe that you should have the opportunity to discuss that treatment plan and alternatives with your doctor
- If a procedure is ordered, we believe that you should be reevaluated after the procedure to determine your response to that treatment
- We believe that the clinician who is in charge of your care (internist, family practitioner, physicians assistant, nurse practitioner, chiropractor) should always be aware of our plan of treatment, and your response to that treatment, through timely written reports
- We believe that surgery should only be considered as an option after all possible conservative alternatives for treatment have been exhausted.
How are we different?
In most communities, the treatment of degenerative conditions of the spine and joints are addressed by a number of different medical specialties. Each specialist has his or her own approach.
A spinal injection may be ordered. While there are 3 different types of epidural steroid injections, the exact type of injection may not be specified by the ordering physician. Sometimes, the level of the injection is not specified. This information may mean the difference between relief or continued discomfort, with added expense (and risk) of a procedure that did not provide relief.
If an epidural steroid injection is ordered, the patient is often sent to an "injection specialist." Doctors doing these injections may have training in anesthesiology, radiology, or physical medicine and rehabilitation. Not all physicians who do procedures are fellowship trained in interventional pain management. (A fellowship is an additional year of training after one completes a residency in their area of specialty.)
When you are seen by an anesthesiologist or radiologist for a procedure, the physician performing your spine injection will often not perform a detailed physical exam of your joints, muscles and nerves. Where the radiologist will review your MRI films, the anesthesiologist will more often review a written report.
After your procedure has been performed, you will usually be sent back to the doctor who ordered the procedure. If the injection did not provide significant relief of symptoms, your physician may urge you to choose a surgical option for treatment. Many other alternatives may not have been considered.
This common model poses a number of challenges:
The first referral choice may be to a surgical specialist (Orthopedic Surgeon or Neurosurgeon) as ordered by your family practitioner or internist. Surgeons spend years in training and keeping up with the latest surgical techniques. While extremely skilled in the area of their surgical field, they may not be familiar with the many conservatitve non-surgical treatment options for spine and joint pain.1) Fragmented care occurs when you are bouncing from physician to physician, and there is no communication between physicians. Life changing decisions are made with incomplete information that is sometimes based on assumptions. (If you are receiving injections from a practice with multiple physicians, you may see a different physician each time you go to the practice.)
2) Inefficient care is a side-effect of fragmented care. Inefficient care is costly to you, the patient. Procedures that are performed (without a full musculoskeletal evaluation for all causes of your symptoms prior to the procedure) may not be effective and lead to more aggressive treatment. This translates to increased health care cost to you, longer recovery time, and procedures that carry higher risk.
At the Center for Spine & Joint Wellness, we do not consider this current model to be in the best interest of you, the patient. As a specialist in Rehabilitation Medicine, Dr. Berkwits takes a more comprehensive approach, reviewing your history, performing an examination, looking at your MRI and other films, and discussing various treatment options with you.
If you are beginning to feel like a ball in a pinball machine, bouncing between different clinicians, consider calling us to schedule an initial evaluation.