Neurology Enters the Middle Class and Medicare Recognizes TBI as a “Chronic Health Condition”

That’s a funny title. But don’t worry. I’ll connect those two ideas.

I grew up in Bellingham in the 1970s. The people with money were the doctors, lawyers and fishermen. I wanted to be one of those people.

But a lot has changed since the 1970s for all three of those professions. Maybe the most for doctors. And especially for neurologists.

There was a piece in the May 20, 2010 Brain & Life publication called: The Demise of Private Practice Neurology: Death by a Thousand Cuts.

Many neurologists have been run out of private practice by hospitals. And then hired as employees by the hospitals and put to work.

I deposed a neurologist a couple of years ago. She made approximately $124,000 a year. The median household income in Seattle is $121,000. Some economists say $140,000 a year is the new poverty line.

So, desperate to maintain the lifestyles they once knew (or hoped they would know), some neurologists sold themselves out to auto insurers. The mission? To perpetuate disinformation about how difficult it is to sustain a concussion and that those people who do suffer concussions get better in two weeks.

(These neurologists are beginning to look more and more like the doctors who testified to Congress that cigarettes don’t cause cancer.)

I try to use different words. But I say the same thing over and over and over:

Traumatic brain injuries aren’t a one-time event from which people gradually “recover.” TBI is the beginning of a disease process. It’s like the first domino to fall. And that first domino can cause a cascade of events that impacts multiple organ systems as a result of metabolic, hormonal and inflammatory changes.

There are a couple of reasons I keep repeating the message. One is probably to help myself understand it so I can better represent our clients who have suffered brain injuries. Another is that these rogue neurologists continue to testify in our cases that brain injury is a compartmentalized event and that it doesn’t have long-term effects. The only way to counter that misinformation is to continue speaking the truth.

[Aside: I’ve focused on neurologists. But there are definitely some neuropsychologists who fall in the same camp. One of the most prolific worked for the VA before she started doing forensic work. She has testified that members of the armed services primarily have somatic symptoms (symptoms caused by psychological mal-adaptation) rather than brain injury residuals. Her opinions are now really being discredited by wave after wave of studies that show the multitude of ways service members have suffered brain injuries riding in vehicles, shooting their weapons, etc.]

Warren Buffett said: Only when the tide goes out do you discover who's been swimming naked.

Well, the tide has gone out. The Centers of Medicare and Medicaid Services (CMS), the federal agency that administers Medicare and Medicaid, now recognizes TBI as a chronic health condition.

This will lead to both increased public health resources – to address the lifelong impacts of brain injury – and to enhanced benefits from health insurance plans like Medicare and Medicaid.

And it will reveal that the neurologists—who have testified that everyone gets better in two weeks—are swimming naked.

These “concussion deniers” still insist that the sun rotates around the earth. Juries will begin to mock rather than believe them. That will be their legacy.