[Mark in Idaho]

One of my sources of research is online CME courses. These are the Continuing Medical Education courses that are required for medical professionals to maintain their credentials/board certifications, etc.

During a recent course taught be a multi-disciplinary group of specialists who, combined, begin to rate at an expert level, one important point was made:

One expert stated that the first priority with concussion is to stop denying care to PCS subjects. He stated that this requires that medical records properly list concussion as an early diagnosis (ICD-9 diagnostic code 854.0 ). This way, when symptoms become evident at a later date, they can be considered as possibly caused by the previous/recent concussion. Otherwise, later care is refused and the symptoms are labeled somatoform, psychological, or malingering.

The comments focused on the comprehensiveness of a medical history. This included asking specific leading questions. It was recognized that most concussion subjects are poor at self reporting. Thus, they need to be queried as to any slips, falls, or other accidents that may have caused any level of impact to the head.

This might even include asking if the subject plays any sports like hockey, basketball, football, soccer, rugby, baseball, lacrosse, etc. where impacts to the head are common during play. The importance of this was to include the risk that a head impact may have occurred that was disregarded or forgotten (may times due to short term amnesia during the moments of impact).

They discussed the need to probe into any vague symptoms such as foggy brain, spinning head, just not feeling myself, groggy, and the vast myriad of subjective complaints that are often overlooked. If any of these complaints could be a result of a concussion, they should be considered as possibly due to a concussion until a concussion of any severity is ruled out.

They implied that it is better to have a medical record state 'possible concussion, ICD-9 code 854' to allow for follow-up without a conflict with the second party health care payer.

As most of us have run into the wall of denial of care, this recommendation make total sense. Maybe we need this post to be a 'sticky' that discusses the priorities of a concussion from this perspective. I would suggest that many of us have had somatoform, malingering, hypochondriac, etc stated in our medical records because there was never a proper previous listing of concussion nor a proper medical history taken.

We all need to consider that we have the greatest influence in the care we receive. If we just sit back and wait on others to stick up for our concussion needs, we will be left wanting.

[Theta Z]

Thank you, Mark, for this reporting of great importance to us! Yes, yes.

The problem(s) I have encountered have been just mind-boggling to anyone of even simply "good, decent common sense", much less being cognitively dis-advantaged in terms of MTBI/PCS and dealing with medical care.

For example, even though the E.R. sent me home with *pages* of information and instructions on "Concussion" and "Post-Concussive Syndrome", they *never once* mentioned the *words* or care instructions whatsoever to me verbally.

It was only thereafter in obtaining the radiologist's report of E.R. CT-scan, that I saw clearly noted "Closed Head Trauma". I subsequently saw my neurologist (per E.R. directives for followup) and all he did was a minimal neurological screen and said, " I wouldn't advise anything different than the E.R."

When I inquired as to what I might expect in terms of continuing to "be out of it"/for how long, what about working/driving and inability to drive, intense head pain, nausea, vomiting, unbalanced in walking, sleeping 14-17 hours per day (in 2-3 necessary sleep/brain shutdowns), intense vertigo, falling down, double vision/blurry vision and host of cognitive dysfunctions, inability to even make coffee or tea (forgot "how to") --- neurologist quipped: "You'll get better if you want to." That was it.

I immediately requested copies of medical records from that neuro visit and was simply stunned at the lack of accurate, truthful documentation in the neuro's patient notes!

Maybe it's the State in which I reside, but I have found that docs clearly do not want to accurately document these things as we *accurately report* them in all good faith and trust in their care and service to our well-being.

In fact, I've hence learned that the docs (in this State anyway) are "beholden" to the insurance companies and as well to protect themselves (the docs) from potentially becoming at all involved in any litigation/legal matters. (For example, were I to bring lawsuit against the at-fault driver in the auto collision which caused my injury.)

So, I thank you again. And a reminder to us all, that we're not always the ones who "fail to report adequately". In my own case, it's the docs whose best interest for themselves and the insurance companies is to "under-report" and inadequately document what we do report and present.

Much appreciation to you and all that you help and report here, Mark .

Sincerely,
Theta Z
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Age 57, high-speed, high-impact, rear-ended, totalled my car, auto collision 1 yr 6 mos. ago. "Every day in every way, I affirm that I am better and better in every way. And I give thanks that it is so. And so it is."
MTBI/closed head injury/PCS

[sheds]

Theta Z,

It is not just your State that there is a problem. When I fell from the bed in the ER, there was never any mention of a concussion even though I fell on my head and sustained a nasal fracture. The only person in the ER who acknowledged that there was a problem with the ER doc. He stated in his record about the fall and how the docs/nurses were at fault and in his dictated report list head trauma as a diagnosis. The neurologist that they wanted me to follow-up with was associated with the hospital at fault. Do you think she was going to say that I had a concussion? She blamed my headaches and everything else involved with this to the seizure meds that they put me on in the hospital. So, I saw every professional I thought appropriate to help me get to the bottom of my problems.

I saw a spine PT, a rehab nurse, eye doc, psychiatrist, etc. I finally went to see a Sports Med doc who is familiar with head injuries. After listening to me, I said I was suffering from PCS. In the process, I also changed neurologists. This new doc started working on my headaches right away. Unfortunately, I have not yet found the right meds to help with that. All I wanted my first neuro to say is that I had PCS, but since she was directly related to the hospital, I knew that she wasn't going to implicate them.

I stayed in the hospital for two days. I am pretty sure that they don't do that for people who have suffered from seizures. They prescribe you meds and send you home. So, I am guessing that I was there because of the head injury although that was never mentioned. I also received no information regarding PCS. So, all the things that came up after the fall where things I never knew could happen. My family doc, who also practices for the hospital, told me I was depressed and prescribed antidepressants. When I went back to here a few months later still with headaches, she said I was depressed and needed to see a psychiatrist. Saw a psychiatrist and he told me I wasn't depressed and took me off the antidepressants.

I could go on, but I think a lot of people on this thread have had some sort of this problem. Your State is not the only one!!