Here's a follow up to last week's post, 5 Reasons Why History Matters! This time, it's 5 Reasons Why History May Not Matter.
1) The patient is focused on passive treatment
- "I've been going to practitioner x for 10 years - always keeps my back in alignment"
- Since I've never seen a patient for 10 years (and yes, I've been practicing longer than that), my question is, "What do you really think they're doing for you?
- We need to get out patients away from treatments that they think they need repeatedly and get them responsible for their health and well being
- An education on temporal effects of manual therapy, and the need to constantly self reinforce the treatments received in the clinic is always in order for lasting improvement and prevention of recurrence
2) The patient's head is filled with doom and gloom over their condition
- If they've had scans, EMGs... etc... do not look at them, get the emphasis away on thought viruses
- in terms of ruling out, do not worry, if their was a nonmechanical reason why they have their complaints, those tests would have ruled them out (fracture, tumor)
- My treatment is based on my evaluation - not what your back, neck etc looks like lying in a tube
- that does not tell us how well you move, your functional levels, etc
- education on false positives, what the average body part looks like under scanning, research showing both knees look the same under scans, 30-80% of the population having positive findings and still being asymptomatic are all warranted, and should be where you start
3) The source of the pain is not the location of the pain
- patient who has repeatedly gotten cortisone injections or TrP injections without checking a referral source
- clinican x has never put them through a repeated motion exam and/or a SFMA to check for adjacent dysfunction
4) They have been to a "insert endless sea of practitioners here" and it did not help
- endless passive treatments
- no education or prevention
- no emphasis on home exercises or correction
- no 1:1 care
- I try not to listen or to emphasize what has worked or not worked in the past, and depending on my mood I usually say "Let's just start fresh and you may have been doing what was best for you before, but the condition may be different, even if it feels the same."
5) The patient repeatedly tells you nothing they do aggravates their complaints
- You have to be dead to be doing nothing
- if it's nothing, it often equals sitting, or absent minded activities such as (recent real examples)
- flared up lumbar spine - 6 hours of studying til 3 am, then 3-4 hours of sleep - nightly
- flared up TMJ - caught reading her iphone in the waiting room with head SB away from the involved side and with her other hand resting on the left mandible - not a WB joint!
- they say the exercises (that worked in the clinic) did not work at home
- they are doing them wrong
- direction (Cervical SB away instead of toward Sx)
- they are not doing them enough (2-3 times/day) when instructed to be hourly
- they added extra exercises other than what you showed them
- so the history rarely matters if they tell you nothing is aggravating their complaints - be a detective and ask more about what they do throughout the day, just prior to or during their flareup
In short, the history matters and also does not matter (although I lean toward it mattering more which is why I wrote that post first). I hope everyone has a great weekend!