EP 49: Treating Catastrophic Injuries with Dr. Erik Bendiks (Part 2)

Welcome to the catastrophic comeback podcast with American Injury Lawyer Clark speaks, helping you find hope, purpose and joy after a catastrophic injury.

How many what percentage of your patients? Do you feel like you say, telemedicine versus in person?

Wow. I don't know an exact, but I would definitely say it's growing, it would not surprise me if it's at least a good 40%. It might even be 50%

Are there circumstances in which you, you have to see them in person? Oh, for

sure. It's always, ideally, you definitely want to have an in person physical exam, if possible. But there are certain diagnoses that may not require nearly as much or certain circumstances where it's just not going to be possible they live, you know, 300 miles away or, or do not have access to a vehicle. But ideally, for a lot of the orthopedic conditions that I evaluate, I'm able to do an exam that's of sufficient quality to be able to do to be able to care for them in an adequate manner. That is not going to compromise their health. And so we're able to do quite a bit via telemedicine, you can talk to the patient, you can do a more focused physical exam, but an adequate physical exam for the physical for the patient, in most circumstances, you can review their labs, you can review their imaging studies, because now a lot of that stuff is online. So you can actually share your, your screen with the patient and show them in real time here. This is the MRI, this is the CT scan, you see your shoulder, it's right here, here's the problem, and pointed out to him, show them their lab values, all that kind of stuff. So with the benefit of technology, you can do so much in a much more time efficient manner.

So I guess you're able to do you're able to take a history, you're able to review notes, you're able to talk to them about what happened to them, you're able to see film, you're able to see the imaging, you know, the X rays, you're able to see MRIs MRI reports. So you have all of that information there. And you can ask them the questions. I guess the only thing that you couldn't do is just like, put your hands on or ask him to ask him to do this or maneuver him in a certain way. Is there certain

sure there's certain physical exam components that you would not be able to do, but there are others that indeed you can do, you can still do assessment for motion for range of motion for strength, you're going to get the basics, if they're standing up, you're going to know that certain motor muscle groups are functioning to a to a to a minimum amount. And so there's still quite a bit that can be done via the telemedicine platform.

And then if you need to do something a surgical procedure or therapy, you can just prescribe it from there and they come back and and

ultimately, you know, if we're doing surgery, we certainly want to be able to evaluate them at one point oftentimes though, they can be evaluated by another similar specialist. So within orthopedics, for instance, in my practice, we also have doctors that are non surgical orthopedist, which is called physical medicine and rehab, but it's basically an orthopedist who doesn't operate. They can do physical exam on the patient, they might see him in a different clinic than me, but I trust their physical exam, then ultimately, I may see them via telemedicine and say, Yeah, I do think you need a neck surgery or a back surgery. And then possibly the morning of when I actually see them in the operating room or just before the operating room at the hospital or in the surgery center. I'll do a physical exam just to confirm that that's what the non surgical orthopedist saw, make sure everything lines up and then we proceed to surgery.

So are there would there be physicians in each one of your different offices that doctors and each one of your orthopedic doctors and each one of your different offices,

we do have multiple orthopedic doctors, multiple physical medicine and rehab doctors, we have nurse practitioners with pas physician assistants or nurse or our pas and nurse practitioners also function helping the doctor they can be to a certain degree independent and can take care of patients independently but they still work with the doctor that supervising them to deliver health care.

Okay, so So you're in charge of that whole group and then in addition, are you are you the only or the orthopedic surgeon in your? No,

we have several other orthopedic surgeons we have two general orthopedist that do extremities so extremities we mean arms and legs so that means shoulders, knees, ankles, wrists, elbows. We also have two spine surgeons. I'm one of them in the group. We have three physical medicine and rehab doctors in the group. We have a couple of nurse practitioners and we have multiple physician assistants. Yeah,

so So technology is something that's gone a long ways towards helping you be able to To help more people treat more people improve the lives of the patients that you are more people that you're able to treat. One of the things that we were looking at in this in this podcast is, you know, people that have catastrophic injuries and not all of our cases involve catastrophic injury. So most of our cases, involve people that get that have, you know, they're they're driving down Independence Boulevard, and somebody rear ends them. They're driving down Market Street, somebody pulls out in front of them, they, you know, and they can they get treatment, you know, they get, maybe they have a consultation, there's a course of physical therapy, there's a reevaluation, you know, and then they, and then, you know, but some of the cases that were involved in have more serious, you know, lifelong challenges, either paralysis, or, you know, you know, some cases death. And then sometimes it's like a just a serious back injury that might involve surgery might involve fusions might involve future medical treatment, do you deal with some of those issues? We

do, just just because that's the nature of orthopedics is dealing with injuries. So it's not, it's not just conditions that you might be born with. But it's also acquired things that happened during your lifetime, which trauma can be, you know, falling off a roof or I was speaking with somebody the other day about a patient that I had, who was an on a fan boat in the Everglades, and they hit a stump, and he fell off and got his leg cut off. Unfortunately, it was a young kid. So that would be a catastrophic injury, it's going to it's going to be life changing for that boy, to have to deal with the loss of his leg, just not just the the psychological aspect of it. But the physical aspect, it changes your body, obviously, when you've had an amputation, and this young man, he was a, he was like a 1819 year old kid. And we had to deal with the amputation, we had to prepare the leg to be able to close the wound. And obviously, the water in the Everglades is not the cleanest, and you know, there was a large infection there, we had to deal with that we finally got that cleaned out, get the wound closed, and they have to prepare the leg to be able to fit into a prosthesis, there's a there's a lot that goes into that. And then ultimately, just the Nautilus not only the psychological aspect of that, but then just the physical, because you're now missing an extremity, you're going to have to redistribute all of those energies of movement have ambulation to your other body parts. And so that's going to affect those other body parts. So you tend to see that a young person who's had an amputation, they're going to be using crutches a lot more. They're so they're going to be putting a lot more pressure on their upper extremities, their arms for the rest of their life. What's that kind of what impact is that going to have on them? Well, you're going to see a much higher chance of having elbow issues, wrist issues, rotator cuff tears in those people. You know, he's that was back in my training. So that would be 2223 years ago. So he's not an 18 year old now. Now he's middle aged, maybe 40s 40. Somethings don't tend to just get rotator cuff tears, you know, injuries in their shoulders, unless, you know, they're doing a sporting activity or some sort of work related thing, but it's not a common thing. But in somebody who's had an amputation, yeah, it's actually quite common by that age, because they've put so much pressure for the last 20 years on their arms, having to walk with crutches. So that's something that you have to keep in mind, you know, not only for the patient, but obviously for your specialty as well is that's going to be something in the future that they might have to deal with, at a much higher chance than the general population would.

So it's funny, you mentioned that. So we talked about that several times this week. One of the things you know, so where we get involved is after something traumatic happens to someone, if there is liability if someone else calls it or contributed to it or whatever, then we can sometimes get in and try to get people to financial compensation that will allow them to, to pay for medical treatment to pay for lost wages to pay for compensating for pain and suffering. And so it becomes a situation a lot of times in some of these catastrophic cases, how well we can document the impact that this accident or injury has had on a person's life and a person's family. And you know, it's pretty easy to to pull medical records and, and to me, you got the hard job in this whole thing. You got to put people back together from from our point of view, at that point. We're pulling medical records, we're pulling the the investigative materials and all that where it gets a little bit more challenging from our perspective is where we have to go Trying to figure out how to quantify loss. And the way to do that is to figure out, okay, what types of future problems might this person have? And so that's why it is critical for us to to be able to, to talk to not every physician, in my experience, not every physician understands how important it is to quantify that, that future element of recovery of the you know, not just physically, what are the challenges that the person who's has a permanent injury might face? And in your example, the amputation is a perfect example. Right? But also, financially, emotionally, you know, what I mean? What's, what's the, what's the emotional impact of that, but financially, if that person is on crutches, or if that person, you know, is now having to shift weight to the other leg, and that other knee, gives out that other hip minster has problems requires therapy, replacement requires replacement. And then, and then also, I can't help thinking, my mother is, is 86 years old, and she's we're real close. And she's lived with our family for a long time. And, and I keep thinking, you know, what about when US persons at age, you know, what are these? What are these permanent injuries to this knee or to this hip do to the rest of the body over time, and what's the impact, and what's the financial and physical cost of that going forward? It's,

we have a finite number, a limited number of joints, and muscles in our body, and they handle all the stresses of our life and day to day activities. If you miss some of those, or you lose some of those as a result of injury, or, or infection or whatever reason, necessarily, those stresses have to be now distributed over what's remaining. And those other body parts have to pick up the slack and work harder. And so they can wear out sooner, that's like what we do in for, for me, as a spine specialist, we will often treat damaged or worn out joints in the neck or the low back by gluing that joint together. And that's called a fusion when you glue a joint together, that gets rid of those two bones that are rubbing against each other and the pain coming from that. But the problem is, is that once you've glued that joint together, the other neighboring joints have to pick up the slack and work harder. So 80 years ago, we didn't have hip knee replacements. So we just glued people's legs straight, and they would have to walk with a straight leg. And what we saw from that was man, those people that are walking around with a straight leg like that, they're wearing out their ankle a little bit fast, but they're definitely wearing their hip out really fast. And so when that technology came along to be able to replace a joint, rather than glue that joint together, we've started doing that as within the orthopedic community and seeing a big change. And so now we've had artificial knees and artificial hips for decades now, in spine that's only finally showed up in the last 20 years or so we now have artificial discs for the neck and for the low back. And what we've seen is that does have an impact because when we glue a joint together in the neck, or we glue a joint together in the low back, the other remaining ones do work harder. And so there is an increased chance of those neighboring joints to wear out. And now with artificial discs, we're not seeing that increase. So that has a big impact. And it's important for the physician for the orthopedist, to know that so that they can speak to yalls professional legal community to be able to inform y'all okay, this is what is going to be Mrs. Jones is going to be phased in for the rest of the rest of her life, trauma, orthopedic traumatologist. So the Orthopedic Specialists that just deal with trauma, people that go to the trauma center with a broken pelvis or a broken thigh bone called the femur or whatever they're often treated at a trauma center by traumatologist. Those Those doctors, those specialists are probably can be very helpful for giving what would be expected future issues in for a patient like that after a major traumatic event. There's in fact a whole industry that deals just with that. They're called life care planners, as you well know. And those are folks that can help kind of map out okay, this is what Mrs. Jones is going to need in the future as a result of losing the the you know, all of the toes on her right foot and she's not going to be able to walk as well. She will need therapy, she will need a special shoe prosthetics and orthotics

should wear out every six months and she won't need to replace it. Yeah,

that's what those specialists do. They know all that information or they've studied that and then they'll work in concert with the doctor because the doctors may not always know all that stuff. They might know oh, they're going to need you know when you've got an amputation. You're going to now need a spine Shall bed to sleep in, or you're going to need a harness to get you in and out of the shower to be able to shower and that harness will wear out probably every couple of years. And Mrs. Jones is only 32. She's going to live another, you know, 48 years. So you're going to need, you know, probably 18 More harnesses or something like that. That's where life care planners can help inform the doctor and then together, the doctor, along with the Life Care planner can come up with okay, this is likely what Mrs. Jones is going to be facing and we're going to be needing for the rest of her life.

So we had one of these life care planners Shawn Seaver on a couple of months ago, so she's in a previous episode, we'll try to provide a link to in the in this episode to that one so people can see a little bit more about what you're talking about. Thank you for joining us, and we'll see you next time.

Welcome to the catastrophic comeback podcast with American Injury Lawyer Clark speaks, helping you find hope, purpose and joy after a catastrophic injury.

How many what percentage of your patients? Do you feel like you say, telemedicine versus in person?

Wow. I don't know an exact, but I would definitely say it's growing, it would not surprise me if it's at least a good 40%. It might even be 50%

Are there circumstances in which you, you have to see them in person? Oh, for

sure. It's always, ideally, you definitely want to have an in person physical exam, if possible. But there are certain diagnoses that may not require nearly as much or certain circumstances where it's just not going to be possible they live, you know, 300 miles away or, or do not have access to a vehicle. But ideally, for a lot of the orthopedic conditions that I evaluate, I'm able to do an exam that's of sufficient quality to be able to do to be able to care for them in an adequate manner. That is not going to compromise their health. And so we're able to do quite a bit via telemedicine, you can talk to the patient, you can do a more focused physical exam, but an adequate physical exam for the physical for the patient, in most circumstances, you can review their labs, you can review their imaging studies, because now a lot of that stuff is online. So you can actually share your, your screen with the patient and show them in real time here. This is the MRI, this is the CT scan, you see your shoulder, it's right here, here's the problem, and pointed out to him, show them their lab values, all that kind of stuff. So with the benefit of technology, you can do so much in a much more time efficient manner.

So I guess you're able to do you're able to take a history, you're able to review notes, you're able to talk to them about what happened to them, you're able to see film, you're able to see the imaging, you know, the X rays, you're able to see MRIs MRI reports. So you have all of that information there. And you can ask them the questions. I guess the only thing that you couldn't do is just like, put your hands on or ask him to ask him to do this or maneuver him in a certain way. Is there certain

sure there's certain physical exam components that you would not be able to do, but there are others that indeed you can do, you can still do assessment for motion for range of motion for strength, you're going to get the basics, if they're standing up, you're going to know that certain motor muscle groups are functioning to a to a to a minimum amount. And so there's still quite a bit that can be done via the telemedicine platform.

And then if you need to do something a surgical procedure or therapy, you can just prescribe it from there and they come back and and

ultimately, you know, if we're doing surgery, we certainly want to be able to evaluate them at one point oftentimes though, they can be evaluated by another similar specialist. So within orthopedics, for instance, in my practice, we also have doctors that are non surgical orthopedist, which is called physical medicine and rehab, but it's basically an orthopedist who doesn't operate. They can do physical exam on the patient, they might see him in a different clinic than me, but I trust their physical exam, then ultimately, I may see them via telemedicine and say, Yeah, I do think you need a neck surgery or a back surgery. And then possibly the morning of when I actually see them in the operating room or just before the operating room at the hospital or in the surgery center. I'll do a physical exam just to confirm that that's what the non surgical orthopedist saw, make sure everything lines up and then we proceed to surgery.

So are there would there be physicians in each one of your different offices that doctors and each one of your orthopedic doctors and each one of your different offices,

we do have multiple orthopedic doctors, multiple physical medicine and rehab doctors, we have nurse practitioners with pas physician assistants or nurse or our pas and nurse practitioners also function helping the doctor they can be to a certain degree independent and can take care of patients independently but they still work with the doctor that supervising them to deliver health care.

Okay, so So you're in charge of that whole group and then in addition, are you are you the only or the orthopedic surgeon in your? No,

we have several other orthopedic surgeons we have two general orthopedist that do extremities so extremities we mean arms and legs so that means shoulders, knees, ankles, wrists, elbows. We also have two spine surgeons. I'm one of them in the group. We have three physical medicine and rehab doctors in the group. We have a couple of nurse practitioners and we have multiple physician assistants. Yeah,

so So technology is something that's gone a long ways towards helping you be able to To help more people treat more people improve the lives of the patients that you are more people that you're able to treat. One of the things that we were looking at in this in this podcast is, you know, people that have catastrophic injuries and not all of our cases involve catastrophic injury. So most of our cases, involve people that get that have, you know, they're they're driving down Independence Boulevard, and somebody rear ends them. They're driving down Market Street, somebody pulls out in front of them, they, you know, and they can they get treatment, you know, they get, maybe they have a consultation, there's a course of physical therapy, there's a reevaluation, you know, and then they, and then, you know, but some of the cases that were involved in have more serious, you know, lifelong challenges, either paralysis, or, you know, you know, some cases death. And then sometimes it's like a just a serious back injury that might involve surgery might involve fusions might involve future medical treatment, do you deal with some of those issues? We

do, just just because that's the nature of orthopedics is dealing with injuries. So it's not, it's not just conditions that you might be born with. But it's also acquired things that happened during your lifetime, which trauma can be, you know, falling off a roof or I was speaking with somebody the other day about a patient that I had, who was an on a fan boat in the Everglades, and they hit a stump, and he fell off and got his leg cut off. Unfortunately, it was a young kid. So that would be a catastrophic injury, it's going to it's going to be life changing for that boy, to have to deal with the loss of his leg, just not just the the psychological aspect of it. But the physical aspect, it changes your body, obviously, when you've had an amputation, and this young man, he was a, he was like a 1819 year old kid. And we had to deal with the amputation, we had to prepare the leg to be able to close the wound. And obviously, the water in the Everglades is not the cleanest, and you know, there was a large infection there, we had to deal with that we finally got that cleaned out, get the wound closed, and they have to prepare the leg to be able to fit into a prosthesis, there's a there's a lot that goes into that. And then ultimately, just the Nautilus not only the psychological aspect of that, but then just the physical, because you're now missing an extremity, you're going to have to redistribute all of those energies of movement have ambulation to your other body parts. And so that's going to affect those other body parts. So you tend to see that a young person who's had an amputation, they're going to be using crutches a lot more. They're so they're going to be putting a lot more pressure on their upper extremities, their arms for the rest of their life. What's that kind of what impact is that going to have on them? Well, you're going to see a much higher chance of having elbow issues, wrist issues, rotator cuff tears in those people. You know, he's that was back in my training. So that would be 2223 years ago. So he's not an 18 year old now. Now he's middle aged, maybe 40s 40. Somethings don't tend to just get rotator cuff tears, you know, injuries in their shoulders, unless, you know, they're doing a sporting activity or some sort of work related thing, but it's not a common thing. But in somebody who's had an amputation, yeah, it's actually quite common by that age, because they've put so much pressure for the last 20 years on their arms, having to walk with crutches. So that's something that you have to keep in mind, you know, not only for the patient, but obviously for your specialty as well is that's going to be something in the future that they might have to deal with, at a much higher chance than the general population would.

So it's funny, you mentioned that. So we talked about that several times this week. One of the things you know, so where we get involved is after something traumatic happens to someone, if there is liability if someone else calls it or contributed to it or whatever, then we can sometimes get in and try to get people to financial compensation that will allow them to, to pay for medical treatment to pay for lost wages to pay for compensating for pain and suffering. And so it becomes a situation a lot of times in some of these catastrophic cases, how well we can document the impact that this accident or injury has had on a person's life and a person's family. And you know, it's pretty easy to to pull medical records and, and to me, you got the hard job in this whole thing. You got to put people back together from from our point of view, at that point. We're pulling medical records, we're pulling the the investigative materials and all that where it gets a little bit more challenging from our perspective is where we have to go Trying to figure out how to quantify loss. And the way to do that is to figure out, okay, what types of future problems might this person have? And so that's why it is critical for us to to be able to, to talk to not every physician, in my experience, not every physician understands how important it is to quantify that, that future element of recovery of the you know, not just physically, what are the challenges that the person who's has a permanent injury might face? And in your example, the amputation is a perfect example. Right? But also, financially, emotionally, you know, what I mean? What's, what's the, what's the emotional impact of that, but financially, if that person is on crutches, or if that person, you know, is now having to shift weight to the other leg, and that other knee, gives out that other hip minster has problems requires therapy, replacement requires replacement. And then, and then also, I can't help thinking, my mother is, is 86 years old, and she's we're real close. And she's lived with our family for a long time. And, and I keep thinking, you know, what about when US persons at age, you know, what are these? What are these permanent injuries to this knee or to this hip do to the rest of the body over time, and what's the impact, and what's the financial and physical cost of that going forward? It's,

we have a finite number, a limited number of joints, and muscles in our body, and they handle all the stresses of our life and day to day activities. If you miss some of those, or you lose some of those as a result of injury, or, or infection or whatever reason, necessarily, those stresses have to be now distributed over what's remaining. And those other body parts have to pick up the slack and work harder. And so they can wear out sooner, that's like what we do in for, for me, as a spine specialist, we will often treat damaged or worn out joints in the neck or the low back by gluing that joint together. And that's called a fusion when you glue a joint together, that gets rid of those two bones that are rubbing against each other and the pain coming from that. But the problem is, is that once you've glued that joint together, the other neighboring joints have to pick up the slack and work harder. So 80 years ago, we didn't have hip knee replacements. So we just glued people's legs straight, and they would have to walk with a straight leg. And what we saw from that was man, those people that are walking around with a straight leg like that, they're wearing out their ankle a little bit fast, but they're definitely wearing their hip out really fast. And so when that technology came along to be able to replace a joint, rather than glue that joint together, we've started doing that as within the orthopedic community and seeing a big change. And so now we've had artificial knees and artificial hips for decades now, in spine that's only finally showed up in the last 20 years or so we now have artificial discs for the neck and for the low back. And what we've seen is that does have an impact because when we glue a joint together in the neck, or we glue a joint together in the low back, the other remaining ones do work harder. And so there is an increased chance of those neighboring joints to wear out. And now with artificial discs, we're not seeing that increase. So that has a big impact. And it's important for the physician for the orthopedist, to know that so that they can speak to yalls professional legal community to be able to inform y'all okay, this is what is going to be Mrs. Jones is going to be phased in for the rest of the rest of her life, trauma, orthopedic traumatologist. So the Orthopedic Specialists that just deal with trauma, people that go to the trauma center with a broken pelvis or a broken thigh bone called the femur or whatever they're often treated at a trauma center by traumatologist. Those Those doctors, those specialists are probably can be very helpful for giving what would be expected future issues in for a patient like that after a major traumatic event. There's in fact a whole industry that deals just with that. They're called life care planners, as you well know. And those are folks that can help kind of map out okay, this is what Mrs. Jones is going to need in the future as a result of losing the the you know, all of the toes on her right foot and she's not going to be able to walk as well. She will need therapy, she will need a special shoe prosthetics and orthotics

should wear out every six months and she won't need to replace it. Yeah,

that's what those specialists do. They know all that information or they've studied that and then they'll work in concert with the doctor because the doctors may not always know all that stuff. They might know oh, they're going to need you know when you've got an amputation. You're going to now need a spine Shall bed to sleep in, or you're going to need a harness to get you in and out of the shower to be able to shower and that harness will wear out probably every couple of years. And Mrs. Jones is only 32. She's going to live another, you know, 48 years. So you're going to need, you know, probably 18 More harnesses or something like that. That's where life care planners can help inform the doctor and then together, the doctor, along with the Life Care planner can come up with okay, this is likely what Mrs. Jones is going to be facing and we're going to be needing for the rest of her life.

So we had one of these life care planners Shawn Seaver on a couple of months ago, so she's in a previous episode, we'll try to provide a link to in the in this episode to that one so people can see a little bit more about what you're talking about. Thank you for joining us, and we'll see you next time.