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There are a number of disorders that can be responsible for inflicting
back pain. Besides sore muscles and sprains, there are congenital and
degenerative diseases, infections and, on rare occasions, tumors that
can affect the bony and soft spinal tissues.
The spine is a compact environment occupied by bony structures, groups
of muscles, ligaments, tendons, and nerves all living side by side.
This arrangement is similar to a neighborhood (spinal column) where
the homes (vertebrae) have been built close together. If one house
catches on fire (e.g. pain from a nerve that is compressed), the one
next-door will likely be affected in some way. Similarly, it is important
to locate the source of the fire and extinguish it before the whole
block is on fire.
Some patients do not understand why they are in such agony. Their
pain, when linked with apprehension, may promote feelings of anxiety
and fear. Perhaps the patient does not know who to turn to or who to
see about their disorder. Depending upon the parameters of the patient's
health insurance plan, their primary care physician may provide a referral
if it is determined that more than routine care is necessary.
At this point, let's assume the patient has made an appointment to
see a specialist. What is next? It might be a good idea to gather information
the physician needs prior to the office visit. The following checklist
should be helpful.
1. X-rays, MRIs, or other tests performed relevant to the current
problem.
2. Make a few notes describing the type of pain, its location, when
the problem started.
3. Medical history including allergies, illnesses, family medical
history, prior surgeries.
4. The names and dosages of current medications.
5. Jot down questions to ask the physician.
The next step is the physician's examination of the patient. The
examination is made up of three basic steps: 1) Review the patient's
medical history, 2) the physical examination, and 3) diagnostic tests,
if needed. After the patient completes their paperwork, the assistant
asks the patient questions necessary to complete their preliminary
chart. Shortly thereafter, the physician arrives with the patient's
chart in hand and greets them.
The physician will ask the patient to clarify any unclear aspects
of the medical history. In addition, the doctor may ask auxiliary questions
to gain a good understanding of the patient's past and current medical
condition. Then the conversation will shift to a direct discussion
about the patient's current disorder. After asking questions about
the patient's condition, sometimes the physician is able to arrive
at a preliminary diagnosis by carefully listening to the patient and
analyzing what they have said in terms of symptoms, past medical treatment,
and family history. An accurate diagnosis is the key to the success
of the treatment plan.
The second step is the physical examination. At this point, the patient
may be asked to change into an examination gown. Depending on the patient's
physical condition, the doctor may ask the patient to walk, stand,
sit, and move their arms and/or legs. During this time, the doctor
observes the patient's ability to move and their range of motion. Certain
physical tests examine bilateral response, muscle strength, reflexes,
and palpation.
The last step is diagnostic testing. During the last two steps, the
physician has gathered information regarding the patient's condition.
At this point, the doctor most likely has determined a probable diagnosis.
It is important for the patient to understand that tests are not done
at random. Not every patient's problem will require an X-Ray, CT Scan,
EMG, or lab tests.
Some disorders can be defined by clinical findings. The "clinical
findings" are clues the physician detects during the course of his
examination, both verbal and physical. Most disorders, simple or complex,
have distinguishing characteristics. When testing is ordered, it is
done to confirm the diagnosis.
Diagnostic tests are of great value. When the test results are combined
with the findings from the first two steps, it is a win-win situation
for both the physician and the patient. The physician is able to formulate
an accurate diagnosis and offer the patient the best treatment options.
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