Over a year ago our team began a study to see if simple questions could influence what we felt were unnecessary procedures that our patients were receiving.
We selected any patient who was treated conservatively in physical therapy but still had to go back for a follow up visit with their physician or surgeon to review imaging, or discuss more treatment options like surgery or injections. We only selected patients that self reported over 50% improvement in pain and function in the few weeks they had been treated with physical therapy. (64 total patients.)
We then placed every other patient in a control group or an experimental group. The experimental group simply received a list of multiple questions to ask their doctor at the next follow up appointment.
The first two questions were:
- Is it possible that the problem on the imaging is not actually the source of my pain?
- Will it hurt me to try conservative care like physical therapy for a few more weeks prior to making the surgical decision or the decision on more advanced imaging (MRI’s)?
Over the year the results we saw were staggering. The group that asked these questions in their visit had roughly a 75% decrease in use of further imaging, injections, and orthopedic surgery. And guess what, they all continued to get better.
No, this wasn't a randomized controlled trial, and we didn't run statistics on the outcomes - so you won't see this study in any of our eBooks or videos, but it was the spark that started the idea for ClearCut ORTHO.
Our conclusion was one that is seen on a daily basis in clinics all over the nation...A single question from the patient can significantly change the course of the visit and the treatment options proposed. Guiding the conversation with your doctor can be a powerful tool for what is a very confusing orthopedic journey for most patients (seeing consistent progress in recovery but still being offered more expensive and risky services and treatments to "fix" their bodies.)
The hard part is, these can be tough questions to ask. It's important to remember that your physician has a lot of information he or she is trying to sift through in a very short amount of time (many times under 5-10 minutes.) Often there is a lot of pressure on the physician to give the patient a single diagnosis that covers all their symptoms, and a magic pill or treatment that will take their symptoms away.
Many of the best physicians and surgeons know that these days with so much information online, if they don’t give the patients what they are looking for, they will go to another provider until they find it. It’s a tough balance, trying to explain to a hurting patient that what is best for them may be to avoid the pill or the knife and push through for a few weeks in physical therapy. It’s also very tough to try to explain to a hurting patient that it may not be best to perform imaging immediately. So keep in mind, part of asking these questions is to let your provider know you are ok with putting in the work to get better conservatively and not jump too quickly to treatments you may not need.
Consider this STUDY by Sears and colleagues in 2016. Of 579 surveyed VA clinicians who were given a hypothetical case of a patient presenting with symptoms and history of non-specific low back pain, only 3% of the physicians thought this patient needed imaging, but over 50% worried that the patient would be upset if they didn’t receive the image.
The questions above can let a busy physician or surgeon know that you are interested in being apart of the treatment decisions, and that you’re focused on the best long term outcomes, even if that means choosing conservative care over pills, injections, and surgery (if appropriate based on your situation.)
For more questions to ask, guidance on second opinions, and advice on what the research supports for orthopedic treatment options, check out our series of eBooks and our affordable Telehealth Services.
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