It can be tempting to compartmentalize the tasks required to run a neurology practice, so you can handle just one thing at a time. However, the reality is that medical, financial, marketing, and staffing efforts all overlap to varying extents.
An example of this overlap is in managing EMG referrals to your practice. Conducting and interpreting EMGs clearly falls into the medical practice compartment, but how you write up the report can be an opportunity to make your practice shine above others. A thorough and well written EMG report helps referring physicians provide better patient care. It may also make them want to refer to you in the future.
Devon Rubin, MD of the Mayo Clinic in Jacksonville, FL, focused on this idea at the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) meeting earlier this month in Phoenix. During his session, he discussed the importance of including clinical information in EMG reports.
The AANEM offers a position statement regarding what to include in an EMG report. Dr. Rubin elaborated on these ideas and identified mistakes neurologists often make that limit the utility of the report.
First mistake: The neurologist relies on the referring physician’s patient assessment rather than personally assessing the essential aspects of the history and exam. Rubin emphasized that the specialist is another set of eyes. As such he should combine his own examination with the EMG to form his opinion.
Second mistake: The neurologist focuses only on electrical findings and not a clinical impression. Too often the neurologist doesn’t want to take responsibility for interpreting the findings. However, the referring physician benefits when the specialist provides as much information as possible.
Whether an EMG report should include treatment recommendations is a different question. Rubin offers points to consider when you decide whether to your report will take that extra step:
- Treatment recommendations offer assistance to referring physicians who have limited experience with neuromuscular disorders and their treatment.
- Including this information may also offer a quicker path to treatment for the patient.
- However, an EMG is not a complete neurology consult, so the medical-legal implications must be considered.
So as Rubin explained, this is an “it depends” situation. It depends on who the referring physician is and the neurologist’s relationship with them. The specialist’s clinical confidence should influence whether treatment recommendations are included. And finally, a complete neurological consult calls for more detail than just an EMG consult.
In the end, each neurologist will develop their own method of writing up EMG reports. You will have to determine what to include and what to exclude for yourself. As you do this, remember that this is not only an important medical document but it is a way of providing a desired service for your referring physicians. An EMG report that is beneficial to your referring physician is also beneficial to building your practice.
This is Part 1 of a three-part recap of the session, EMG Reports: Issues of Report Formulation and Conveying Interpretation to Referring Physicians from the 2017 meeting of the American Association of Neuromuscular and Electrodiagnostic Medicine. You can continue reading Part 2, Do Referring Physicians Understand Your EMG Reports? and Part 3, How to Formulate an EMG Report for Utility and Reimbursement, here on Neurology Insights.