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June 13, 2003     Cape Gazette
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June 13, 2003

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78 - CAPE GAZETTE, Friday, June 13 - June 19, 2003 HEALTH & FITNESS Population boom, laws cause delays for patients Physicians seek solutions for waiting time problems The doctor's appointment is at 3p.m. The patient arrives at 2:45 but isn't seen until 4:30. A patient has moderate pain or tries to schedule an annual checkup but learns it will be several weeks or even two months before there's room on the physician's cal- endar. What causes the delays? By Kerry Kester With a steadily increasing population in Sussex County, local medical practices are seeing more patients and suffering from what one local physician calls growing pains. Population growth, however, is not the only cause of problems at doctors' of- flees. Federal regulations and insuraace-re- lated rules also contribute to waiting-room and scheduling delays. "People come in, and they're angry they had, to wait," said Dr. John Spieker, or- thopaedic surgeon at Orthopaedics Associ- ates of Southern Delaware. "We're getting an increasing number of irate patients - and even doctors sometimes - because they can't get an appointment in the time frame they want or the time frame the attending physician wants." Currently in his office, there is often a three- to six-week wait for an appointment for a nonemergent condition. It can also take that long to get appointments for non- emergencies at Bayside Health Association, which includes OB/GYN, family medicine, audiology, otolaryngology and ultrasound. Patients sometimes accuse practices of overhooking, thus caus- ing the waiting:room delays, but that usually isn't the case. Or- thopaedics Associates and Bayside Health, for example, have an esti- mated 10 percent rate of no-shows per day. To compensate, they book KIIJI between 5 and 10 per- cent over. Having a gap between patients isn't an option for most practices because their overhead expenses are ever increasing while insurance reimbursements steadily decline. For example, practices must now employ more people who do not generate revenue. Bayside Health has two full-time employees who do nothing but verify insur- anOS. "Every single patient who walks in - we have to verify the health insurance," said Dr. Vincent Killeen, Bayside president. Addi- tionally, he said, patients must now sign new forms pertaining to the Health Insur- ance Portability and Accountability Act (HIPAA). 'q'hat's tremendously labor in- tensive." Cases more complex In addition to the increase in population and thus an increase in patient demand for service, Orthopaedics Associates has an addi- tional difficulty: more of its patients are increas- ingly of an older popula- tion, which tends to have more complex problems. "Previously, all these people were sent out of the community," said SPIEKER Spieker. "Now we have the expertise and facilities to handle those complex cases here." Nearly always un- known to the physicians and other practi- tioners is what they may find during the course of an examination that could also throw off a schedule. For example, said Spieker, he recently had - in one day - three patients who came to him complaining of back pain, and all three ended up with diag- noses of metastatic cancer. "You can't just spend five minutes with those people," he said. Furthermore, he said, his-practice's philosophy is not to rush a patient, and since patients now are generally more involved in their health care so they often have more questions. "When they have our time, they have our time," said Spieker. With both practices, physicians may also be called for emergencies for which they are summoned to the hospital. "Emergencies destroy the schedule," said Spieker. Orthopaedics Associates has five sur- geons, a physiatrist, a physician's assistant and a pain management specialist, most of whom make demands on equipment in the office, such as the x-ray machine. Some- times backups with imaging creates back- ups in the schedule. Adding another x-ray machine and more practitioners isn't an op- tion, said Spieker, because there is no more space available in his current building, and the new building he's in the process of building won't be ready for quite time. "The schedule is jam packed," said Spieker. Ironically, he said, the Academy of Orthopaedic Surgeons' formula states the Cape Region needs only three or four or- tbopaedic surgeons. "We're at seven [in this area], and we're still hustling," said Spieker, noting other area surgeons are also busy. 'rhe number of patients is not consistent with the population growth numbers." Business challenging "We have to keep [the schedule] flow- Continued on page 84 i Speedy treatment best for whiplash injuries Condition often goes undetected The American Automobile As- sociation estimates there are ap- proximately 6 million automobile crashes every year. More than half are rear-end crashes previous- ly called whiplash injuries, or now known by the term "acceleration- deceleration syndrome." Those injuries and crashes cost the insur- ance industry more than $23 bil- lion in claims each year. Interestingly, the vast.majority of motor vehicle crashes occur at speeds between 6 and 12 mph. This epidemic leaves many in- juries misdiagnosed and often un- der treated. Because of this prob- lem, untreated injuries can often plague an individual for many years to come. Many patients are never fully examined for perma- nent injuries and up to 50 percent of the victims never fully resolve without treatment. Even with treatment, 10 percent will be per- manently impaired. The mechanism of a rear-end impact crash is only now being studied in labs and research cen- ters across the world. Much of the research funded by the insurance industry revolves around protect- ing the vehicle. There are new bumpers made from dent-resistant material, different dampening ef- fects with frame styles and safety restraint systems, including seat belts and air bags. These are all wonderful features that certainly save lives and reduce repair costs, but we have yet to demonstrate good evidence on the damage that can be eansed to the occupants of the vehicles. Let's exnine risk factors pre- disposing an individual to more serious injury in whiplash crashes. Did you know gender plays a big role? A female is more likely to be injured than a male because fe- males have smaller necks to sup- port their heads. During the crash, the smaller muscles may be dam- aged or torn due to size and num- ber. Older patients are also more likely to be injured during a crash because seniors typically have less muscle mass and usually show signs of joint degeneration due to normal aging. As the body ages or degenerates, the underly- ing supportive structures weaken and are unable to absorb much more force than typical stress. A motor vehicle crash overwhelms a senior's musculoskeletal structure resulting in acute and often per- manent injury. Another risk factor for serious injury is previous traumas to af- fected areas. Old injuries heal with scar tissue. The area be- comes less flexible, leading to fur- ther and more extensive stretch injuries. As with women and sen- iors, children have a greater risk of injury because of their sizes and structures. This risk is greatly reduced by properly positioned child-safety seats but even with diligent use, children may still suffer injuries that need to be evaluated and treated promptly. What can be done to help mini- mize whiplash injuries during a rear-end collision? All occupants need to properly adjust head rest upward to fully support the head and neck, Body position, especial- ly neck, will contribute to the ex- tent of injury. If a person's neck is turned, there is a greater amount of force exerted on the facets - joints - that may result in more se- rious injury. The driver should straight arm the steering wheel, placing feet firmly on brake pedal or floor board, look straight ahead, shrug shoulder to ears, slightly tilting the head upward. After the crash, all occupants should be evaluated by a physi- cian trained in motor vehicle-re- lated crashes. A car crash with low speed of less than 5 mph can seriously damage a person's neck, which may result in a variety of symptoms and progressing health problems. It is important to note even though symptoms are not ap- parent at the time of the crash, HEALTH TOPICS Dr. Christopher Baldt is practicing chiropractic med- icine at Long Neck Chiro- practic, 945-4575. which is often the case due to muscle swelling and shock/trau- ma, an auto crash victim should be evaluated immediately. X-rays and other diagnostic testing should be done to quantify the damage and choose appropriate therapy. The tests will help to de- termine if bones have been broken or fractured, muscles have been torn or damaged and if spinal discs are affected as well as "the presence of possible ruptured ten- dons. Medication may be pre- scribed to manage the pain, and often a spinal brace will be recom- mended to help the spine rest. Recent studies in the "American Journal of Orthopedics" demon- strate 86 percent of crash victims benefit from chiropractic care to complement the care received from your emergency medical physician. A chiropractor who is specially trained in dealing with auto-related injuries would be best for initial treatment. Because of the nature of automobile crash- es, spinal joints and discs are of- ten strained or damaged from im- pact and will need treatment to al- leviate pain and discomfort and to help ward off permanent damage. Statistics show that with proper and immediate treatment, 26 out of 28 patients will show signifi- cant improvement and suffer less complications due to injuries sus- tained during automobile and oth- er types of crashes. In my office, my policy is to see crash victims within 24 hours af- ter the crash occurred. I like to work in conjunction with the pa- tient's family physician to insure the most comprehensive care pos- sible. This treatment plan has shown to be very effective in the hundreds of patients I have treated who have experienced crash trau- mas. A good combination of tra- ditional medical care, chiropractic treatments and rehabilitation will greatly improve the chances of avoiding chronic problems in the future.