IN THE REHAB ZONE

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How to Talk to Your Doctor

This is the first article in a series on “How to Talk to Your Doctor.”

(Read the second article in the series here.)

Dealing With the Information Age

Long gone are the days of just trusting your doctor and doing what they say.  No more “take two of these and call me in the morning.” To ensure clear and effective communication it is important to recognize that there is often a disconnect between the patient and his or her physician.

Doctors have a lot of graduate and specialized training, knowledge and experience in the field of medicine and within their respective fields of specialty.  With the advent of the Internet, patients today have access to vast amounts of medical information.  From Web MD, Wikipedia and the like, patients have readily available sources to review should they choose to research their condition.  A typical patient might present to the doctor stating the following:

Patient: “I think I have sciatica.”

Or better, they may say they want blood work done to rule out diabetes and request an A1C blood test.

I believe it is good for humans to have an understanding of their own body.  But unless you went to medical school or are an allied health care professional, the average person is out there without an owner’s manual.

In the past we have been forced to rely on the physician’s expertise.  Much like going to an auto mechanic, the average Joe or Jill is at the mechanic’s mercy due to a remedial understanding of auto mechanics.  Trust and credibility is important.  That being said, taking an interest in your body and its physiology is essential because unlike the ability to buy a new car, you only get one body to go around. It is important to know if what is happening  within your body is the result of altered physiology or is actually a pathology.

A well-versed, well-read patient who has researched his or her condition ad nauseam on the Internet, likely has the knowledge base on that condition similar to that of a second-year medical student. What they lack is the clinical experience gained from years of residency and clinical practice.

That being said, physicians must be able to empathize with their patients and communicate with them in a way the patient can understand what their condition is, what caused it, what the treatment options are, and the risks and benefits of those treatments. With this information, the patient can make an educated and informed decision. The role of the doctor must first be that of a teacher. According to Merriam-Webster’s Dictionary, the definition of doctor is:

a  learned or authoritative teacher.

a person skilled or specializing in healing arts; especially: one (as a physician, dentist, or veterinarian) who holds an advanced degree and is licensed to practice.

A person who restores, repairs, or fine-tunes things.

A Note on Insurance and Managed Care

Remember, that in today’s hectic world of managed care, doctors are forced to see more patients, which often means less face-time with the doctor.  Therefore, efficiency is vitally important to providing quality care.  And being able to verbalize quickly to the doctor what hurts, where it hurts and most importantly, what actions or activities cause pain will speed up the process of diagnosing the cause.  This will enable your doctor to implement an effective treatment.

First Things First

Your doctor must document your pain on what is known as a visual analogue scale (VAS) in which you rate the intensity of your pain from 0-10 (a 10 is pain that would have you in the emergency room for a knife wound, gun shot or an acute appendicitis).  But more importantly, he or she must
document  Activities of Daily Living (ADLs) that you are or are NOT able to perform due to pain.  Unfortunately, the insurance company does not care how much pain you are having.  What they do care about are activities you can and cannot do because of your pain or functional limitation.  Therefore, it is important to convey that information to your doctor for proper documentation.  Insurance companies want to see a treatment plan from your physician.

This plan details what he or she is treating you for, the type of treatment, and the frequency of treatment.  Most importantly, the doctor wants to know what the goals of treatment are. By understanding what activities you cannot perform due to pain, you and your doctor can devise attainable and measurable treatment goals within an expected time frame.

An example may be for a runner having knee pain and cannot run more than 5K due to pain, but is training for a marathon. A great treatment goal for the first month of treatment would be to allow the patient to run distances of 5K three times per week without knee pain. Documenting goal setting like this in detail in the medical record helps medical offices fight claims denials from your insurance company on your coverage because it allows them to report on progress and show that the treatment is both medically necessary and effective.

Let’s Talk Pain

Pain is a primary perceptual experience.  That means only you can tell what type of pain you are having, where you feel it and what description of pain it is.  Therefore, be as specific and descriptive as possible when telling the doctor where you hurt.

When the doctor asks how bad is the pain from 0-10, he needs a number. This is mainly for insurance documentation. After a number is given, then you and your doctor can talk about the really important stuff, like exactly where it hurts, what movements or activities cause the pain.

It is important to know how to describe pain, as different types of pain indicate different anatomical structures.  Sharp pain often indicates nerve pain or severe trauma, deep dull ache usually occurs with muscle tightness, chronic soft tissue injury, and some joint restriction.  Sharp pain with movement can be due to joint inflammation, often due to  joint compression or misalignment.  Numbness or tingling indicates nerve irritation or entrapment (the infamous pinched nerve).

When the doctor is palpating or moving you around to test what hurts, he may ask if a certain pressure or movement makes it better or worse.  It is important to answer quickly.  Pain that is worse will usually be evident immediately.  Answering quickly will result in the doctor ceasing the movement that is causing pain. Remember that pain provocation is one way doctors use to locate what tissues are injured or involved. The more specific you can be with reference to exact pain location and what activities aggravate it the better the doctor can determine the cause.

To repeat: Pain is a primary perceptual experience. Only you know where and exactly how you hurt.

A Note on Dealing with Multiple Areas of Pain

Often times patients present to their doctor with more than one complaint. While some complaints may be related, they may require additional evaluation or testing, involve more treatment or different treatment approach. Therefore, it is critical to give your doctor a hierarchy of your problem list. Determine what is causing you the most pain and disability. What problem do you want to tackle first?  Often times after some treatment, the number one problem begins to respond and that will allow your doctor to focus on other problems on your list.

It is important to note that working simultaneously on two or more problems may decrease the efficiency and effectiveness of the treatment.  It’s like a surgeon trying to do two knee replacements at the same time, with only the allotted time reserved for one knee surgery.  What can happen is the treatment is rushed can and the results can be unsatisfactory.

To repeat: Chunk down your problem list into a hierarchy.  It will pay off in the end.

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