Making an ASS of U and ME
There was a post today on Facebook wherein a young chiropractor was looking for advice on a patient. It made me pause and realize, when looking at all of the suggestions and advice, that most were provided without any initial questions. This partially informed situation led to many assumptions being made by the practitioners wishing to provide some help to this new grad.
It made me reflect on an idea that still creeps into the care I provide daily. We project our thoughts and ideas about what others should want into our goals for care unless we actively work against our own nature.
It is crucial to ask the patient questions to make sure what is important to them is used as a guiding principle in care, as it will typically alter care in some way.
Using the above mentioned patient as an example, he has "ice pick headaches", which are a sudden onset headache of short duration which are intense. He has had them since childhood and is now 40ish. The brief summary provided by the "new grad" was about the patient's belief that they may be tied to neck movement and his worry over them as well as the idea that he is frustrated that his family doctor diagnosed these headaches but provided no suggestions for treatment and the patient is "getting desperate". Now escalation in diagnosis is suggested throughout the recommendations, ordering an MRI, due to suggestions of a Chiari malformation. Potential alternate diagnoses are made, such as TMJ disorder, latent trigger points, craniocervical instability (whatever that is), aerosinusitis...
My question to the new grad was... What impact do they have on his life? What are his concerns/worries about the headaches?
As it turns out the patient had been coming in to see the new grad for other things and mentioned this as one of multiple pain complaints, not the primary reason for seeking care. The headaches are not having a huge impact on his ability to function but are a concern because he has no good explanation for them.
There are opportunities to be better here. Asking questions like, does he need to get rid of the headaches? Or have his fears eased so that he's not freaked out about something seriously wrong with him?
We want to "fix" things, but perhaps some reassurance that it's not abnormal to have a sharp jab of pain in our body sometimes with no obvious stimulus. I get them all the time, sometimes its a sensation of something tickling me, sometimes its a "poking" type of sensation, sometimes an itch for no obvious reason. Being ok with it may actually decrease the intensity of the pain experience for this patient.
We, as practitioners, tend to impose our beliefs about what is best for our patients and it takes some time, maturity and putting aside of ego to get to the right side of that equation.
It's easy to make assumptions, but is often very revealing to ask the right question and realize your job is much easier than you ever imagined.