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Don’t Be The Patient That Says This

Discussion in 'General Discussion' started by The Good Doctor, Apr 5, 2021.

  1. The Good Doctor

    The Good Doctor Golden Member

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    An excerpt from Injured to Elite: A Guide To Empowering Yourself to Transform Your Life After Injury.

    Don’t be the patient that says: “Doc, just tell me what to do …” Instead, you should ask for information to empower yourself to make decisions about your healing process. Framing questions around the clinician’s experience is always a good starting point; pretend to be the doctor for just a moment and consider the difference in how you might answer the following questions:
    1. “Is there something wrong with the X-rays of my spine?”
    2. “In your experience with patients like me, do most people get back to all normal activities following being rear-ended in an accident with findings on an X-ray like this?”
    The first question does not give the clinician an opportunity to see you as an individual and truly help you on your path forward. Instead, it sets up a situation where the doctor is free to look at the X-ray in a general way and give a vague and simple answer. She might say: “No, everything looks fine,” even though your back still hurts, or “… Well, I see you have some scoliosis here,” without giving you any actionable steps to take moving forward. If you keep the focus on the experience of the clinician from their work treating a large number of other individuals with similar patterns of findings, it encourages both of you to keep the bigger picture in mind. But David, you might be thinking, what’s wrong with being told the findings of some specific test or measure? Simple, it’s because one specific test or measure rarely tells the full story. Imaging, for example, is just an illustration of shadows that lay beneath the skin, and has limited capability to depict underlying issues, especially when it comes to a holistic view of the body. In fact, there are specific cases when performing imaging is required by insurance before they are willing to reimburse the clinician for certain procedures to be performed. Unfortunately, this can skew their clinical decision-making. This is yet another reason why you must be the one in control, and work with people you trust.

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    The questions you ask should be specific enough to get a clear answer, but still allow for a meaningful discussion. Providing them with useful details may help towards this purpose; asking when you can return to playing a sport, for example, might depend on the position you play. In Major League Baseball, all 30 teams have a variety of staff focusing on determining a player’s rehabilitation plan and return-to-play progression. This progression is highly scrutinized by an aggregate of knowledge in a multi-disciplinary performance department. A player asking the team physician when they can get back to playing is likely to be given a long-winded answer along the lines of “…We’ll get you into rehab, build you a throwing program with the rehab coordinator, followed by a mound progression, and eventually a game progression.” Naturally, the player will be closely monitored the whole way.

    Not everyone has the luxury of their own organizational rehabilitation coordinator, but you can become your own if you ask the right questions. When I rehabilitated players with the St. Louis Cardinals, I would ask our team physicians questions along the lines of “How long would you recommend a period of no throwing for this pitcher before we begin a light stepwise throwing program?” Even if you aren’t familiar with baseball jargon, you can guess that I wasn’t looking for a black and white answer, but was using questions like this as a jumping-off point to understand the specific complexities and steps of each player’s injury and healing — the “why” was just as important as the “when.” For your own injury, you can ask for an estimated return date, but really aim for answers that teach you what steps to accomplish first, and why.

    Indeed, though a return date (“you can play again on October 4th”) may have a feeling of being specific, it is really quite a subjective answer since so much can happen in the course of rehabilitation. This is why physical therapists, who often spend more time with individual patients than physicians, tend to focus on making and building the progression into a more inclusive process. Still, you are the one making the final call, and asking good questions is the way you build your knowledge base and mental model of the treatment process. The more you know (for this, you depend on the experience of your medical professionals along with your own research), the more empowered you will be as a patient and athlete to figure out your own safe and effective program.

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