organic disorders such as bladder dysfunction • patient has tried many forms of care without success, including physiotherapy, registered mas- sage therapy, drug therapy, ho- meopathy, acupuncture, surgical interventions (though some sur- geries are contraindications for spinal decompression therapy, please see below) and even other chiropractic options, • may be taking anti-inflamma- tories, muscle relaxants or even narcotic pain relievers • patient is often considered to be disabled • all aspects of patient’s life are affected – work, hobbies, family • patient’s emotional health is affected, with some even showing signs of depression. This profile highlights a patient that is complicated and sensitive. The patient brings anger, frustration, fear, skepti- cism, and even depression to your office. The consultation can be a very emotional time for the patient, as they share their story and unburden themselves. They are hopeful, and open to a new sugges- tion, yet wary. Remember, this patient likely has visited many doctors and tried many modes of care before seeing you. CONSULTATION – TRULY GET TO KNOW YOUR PATIENT Prior to the consultation, advise patients to bring copies of X-rays, MRIs, CT- scans, films or disks, or reports, to their consultation appointment. You need to know which tests have been done and which diagnoses have been made. This will help you determine which tests you may need to order. When the patient is in your office, create a safe, trusting environment where he/she can fully explain and share their pain, the circumstances that led to their pain, the impact the pain has made on their life, and all the forms of care they have sought. It’s cathartic, and that’s part of healing. Be as empathetic as possible. Also, and equally importantly, give the patient permission to express exactly what their outcome goals are. Conduct and record a traditional in- terview to collect all the details of the patient’s condition. Perform a thorough systems review. Collect and review pre- 36 • CANADIAN CHIROPRACTOR | MAY 2010 vious traumas, health problems and fa- milial history. Review all films, disks and reports the patient has brought in. And ask the patient what they think might be going on. While listening, you can pick up clues that highlight the patient’s true condition as well as their potential with respect to various therapies, includ- ing non-surgical spinal decompression. Learn as much as possible about the pa- tient’s lifestyle, hobbies, physical fitness, work environment, etc. These factors are of great importance in understanding the source/cause of the spinal problem and, further down the line, in advising the patient on how to protect themselves going forward. When you really listen, the patient sees you as a compassionate and trustworthy doctor. It’s the first step toward creating a healing partnership with a new possibility of success. Do not rush your consultation. This may seem obvious, but it’s essential. Patients are sensitive to feeling pushed through. I’ve heard firsthand from many that it made them feel the doctor was not fully paying attention to them and, worse, hastily led them to a diagnosis and treatment. Compile all the information you have. Proceed with a thorough exami- nation regardless of what your impres- sions may be, at this point, but if you are considering spinal decompression therapy, be vigilant regarding features that may actually be contraindications to this therapy. Simple pre-screening ques- tions should help you easily rule out un- qualified candidates. Contraindications include: • complete laminectomies • advanced spondylolisthesis • pregnancy • surgical spinal hardware implants • cancer • spinal fractures • advanced osteoporosis • possibly ankylosing spondylitis. EXAMINATION – COMPLETE THE PICTURE You now have a puzzle with a few pieces missing. You have a pretty good – but not complete – understanding of the pa- tient’s condition. The examination will fill in these missing pieces. As with the consultation, do not whiz through an examination. This is not appropriate ever – especially not with vulnerable patients. Patient comfort is a priority. You will know, from results of previous tests, if a patient is suffering from a degenerative or bulging/herniated disc. If this is the case, be very conscious of not causing the patient any additional discomfort or pain where possible. Doctors should always begin with complete spinal examination including palpation and range of motion tests. The examination must include a visual in- spection, note any visible antalgic com- pensations. Observe general posture and anatomical landmarks (noting any asym- metries), gait analysis and body weight, and general health as factors. Perform muscle tests, noting both weakness and areas of spasms. Conduct a full range of appropriate neurological and orthopedic tests (including straight-leg raises and Valsalva tests). If your office offers high- tech assessment tools such as surface EMG, perform an appropriate workup. This will help to uncover any neurologi- cal deficits, further identify which nerves are involved and ultimately help with forming an appropriate diagnosis. If there is any doubt of the patient’s diagnosis, it may be necessary to take steps to arrange for appropriate tests such as X-rays, CT-scans or MRIs. Keep in mind that, if you do refer your patient for spinal decompression therapy, it will be important to perform ongoing follow-up assessments through- out the care program to objectively mon- itor the patient’s progress. BE A TRUE HEALING PARTNER Only when you know everything you possibly can about a patient is it appro- priate to make recommendations such as spinal decompression therapy. Whether or not your patient is a good candidate for care, the patient will re- spect your involvement. You have estab- lished a relationship based on compas- sion, expertise, wisdom and trust. For those who do begin spinal decompres- sion therapy care, this foundation can only help in the quest to achieve healing relief. Many of these patients feel they have been on an endless search for pain relief and, with your high standard of consultation and examination, they may be hopeful for the possibility of a bright, pain-free future just ahead. • www.canadianchiropractor.ca
Chiropractic + Naturopathic Doctor May 2010: Page 36
