Monday, December 28, 2015

Are You Looking At Everything? It May Be A Good Idea.

While the phrase "paralysis by analysis" is a concern, often, in healthcare, the opposite can be true. It is not uncommon to experience segmentalized medicine when seeking treatment options for an ailment. With the current state of our healthcare system, doctors are stretched thin. With increased documentation demands, never ending code changes, insurance regulation compliance, decreasing reimbursement, increasing overhead costs, etc., doctors are typically unable to practice using the same model today as even ten years ago. By default, these changes are promoting a segmentalized treatment model. Doctors, by and large, are not thrilled about this emerging reality. But in order to continue helping their patients, doctors are required to adapt their approach. Additionally, training methods have changed. As more discoveries have been made, fields have become quite complex. It is impossible to know everything about everything, so specialists are required to focus on segments of the patient. Many other factors are at play, but suffice it to say that treatment approaches have largely become segmentalized. So how does this effect the patient? In some ways, it means more directed care for a simple or emergent condition. If the patient is feeling chest pain, left arm numbness and/or tingling that radiates into the jaw and other cardiac health signs/symptoms, having segmentalized processes helps expedite the life-saving measures that can save this patient's life. But this model does not work as well for other types of conditions, such as non-specific low back pain. If we approach this condition the same way we approached the earlier symptoms, the results may not be as positive. What happens when a person sees their doctor with low back pain? The typical response from the medical model is an anti-inflammatory, pain medication, and/or a muscle relaxer. Maybe that is the best course of action in this case (certainly I have been told by patients that this approach fixed their back complaints and I am thrilled for that), but maybe it is not. The typical response from the chiropractic model is an adjustment. Will that help? Maybe, maybe not. Most of the time it is hit or miss because the underlying cause of the pain can be difficult to assess during a short examination. And remember, it has already been established that the current system does not lend itself to long, time-consuming examinations. In this case, what is a patient to do? Below are a few helpful tips to help a patient receive the diagnosis and treatment that is best for them.
1) Educate yourself. In this day and age, information is readily available. Know how to describe what you are experiencing, i.e. the pain is sharp, dull, radiating, vague, pin-point, constant, intermittent, worse with activity, no change with activity, worse at night, better/worse with sitting, etc. All of these descriptions mean something and will help in the diagnosis. Look for an internet forum or a few friends/family who may be able to help you identify and describe your symptoms. Being able to elaborate on your symptoms can be of great benefit when describing the condition to your doctor.
2) Remember that your doctor is pressed for time. It is not that your doctor does not care (usually). The reason they do not spend much time with you is because they are trapped in the system described in the opening of this article. Truthfully, they do not like only having a few minutes to spend with you, either. Your doctor did not go into healthcare to ignore you. They went into the field to help people (usually), so make it easier for them to help you in the limited time that they have. Be prepared with a list of questions, an accurate description of your concerns (detailed above), and a little understanding of what the doctor is trying to do for you.
3) Ensure that you are in the correct office. Are you seeing the correct doctor for your condition? You likely would not see a cardiologist for a sprained ankle, so make sure you are seeing the correct provider for the condition. This is another instance where being part of a network of people who have experienced similar symptoms can be helpful (such as an internet forum, etc.) because they may be able to help you decide on a good first step.
4) Have the doctor explain what you can expect. One important aspect to treatment and healing is having a plan. This plan should be fairly direct, but allow for unforeseen circumstances as well. As much as can be expected, try to have an understanding of the course of treatment and what you may be able to do on your own to achieve the overall goal.
5) Seek a provider who will listen to your concerns and approach your condition individually. Not every condition is the same. Similar complaints can require very different treatment approaches (i.e. 'shoulder pain' may require mobility work due to adhesive capsulitis or it may require intrinsic stability work due to a torn labrum. Both of these conditions will produce 'shoulder pain', but if the treatments are reversed, both of these patients could end up in surgery to repair a condition that may have otherwise been managed conservatively. The provider's initial attention to detail is an important factor in creating the proper treatment direction.
There are many other ways to ensure that your treatment(s) are properly devised and managed, but hopefully this discussion gives the patient a few ideas on how to better prepare for a visit and ways to improve the chances of a positive treatment outcome.
All the best,

Nathan Williams, DC, MS

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