Old clinical maxim states healing begins with listening to the history. The cornerstone of an accurate rests upon a detailed history and physical evaluation. The bond of trust that is so integral to the relationship is often determined by the initial detailed evaluation and consultation of the patient.
Obtaining the history is a skill. The secret of history-taking is being a good listener. We try to put our patient at ease by paying attention to all minor details.
When the patient checks in, they fill in their forms in the office for the initial evaluation. It covers in detail their current complaint along with other health issues and their current medical issues. If the patient decides, they can fill out these forms online.
We like to review all of the previous imaging studies, especially the MRI scans done by other physicians. It will reduce duplicity and avoid wasteful reordering of the same imaging studies.
We are very interested in detailed medication history, especially opioids used by the patient in the past. I encourage all my patients to bring their previous pain medication bottles to the office on their first visit. Other drugs that are important in the targeted history are: anticoagulants, like Coumadin, antiplatelets, like Plavix, and aspirin.
The past medical history of the patient�s general health guides us to formulate a treatment plan according to the patient’s health status.
The pain not only affects the patient physically, but it also has a heavy toll on his/her emotional health. It also affects everybody, like family members and colleagues, to come into contact with the patient. We are very interested in knowing the patient’s level of stress inside the home and at work. We ask very specific questions about the patient’s affect, mood, sleep pattern, appetite, and their sports systems to cope with chronic pain.
A detailed physical examination is done following the history as a part of the initial evaluation.
A treatment plan is formulated based on the patient’s condition. It may include physical therapy, anti-inflammtory medications, muscle relaxants, and pain medications.
If the patient fails these conservative treatments, they may require diagnostic and therapeutic nerve blocks. A very small selective group of patients may need more invasive procedures like dorsal column stimulators and intrathecal morphine pumps.
I like to include my patient and his/her families in the treatment plan to have a better outcome for the treatment. We work on a philosophy of having a partnership with the patient for optimal results.
The goal of the treatment plan is to make the patient functional and productive and to improve their quality of life.