My patient has pain in the right hand, which my EMG/NCV last week showed was simply carpal tunnel syndrome. I've scheduled him to see a hand surgeon in a few days.
I understand the MRI of his neck had a few disk bulges and all, which might cause hand pain. But, as is documented in the report and your own note, all those abnormalities are on the left. His symptoms are all on the right.
When he told me that you were insisting he have left-sided "laser neck surgery" for the right hand pain, I figured he'd simply misunderstood what you said, or maybe you'd read the MRI wrong. I do that myself here and there, and have to double check. Hell, I think everyone does.
But when he brought in your printed instructions, with some sort of bogus "referred dermatomal crossing" bullshit about how a pinched nerve on the left can cause "sympathetic allodynic crossover pain" and affect only the right... I told him to run away from you.
I also liked how your note specifically advised him against seeing me to discuss this, and instead recommended a neurologist you have "an affiliation" with. How much of the cut is he getting for being your partner in fraud? I can only assume you've been burned before by other outside docs (like me) telling patients the truth. The part of your note suggesting he not have an EMG/NCV "because it will only delay your pain relief" is a real piece of work. Heaven forbid someone should make the correct diagnosis and rob you of a case.
Your threat about not referring patients to me isn't particularly intimidating. You never have. Now I know why. I have nothing against surgeons. I refer patients to them (when needed) routinely. But I don't take that decision lightly, and keep a short list of surgeons I trust.
So, I don't feel particularly bad that I deprived you of a case. In fact, I hope I have the opportunity to do so again.
Ibee Grumpy, M.D.