I wonder if a doctor would take their own medicine?
I was again confronted by my most irritating pet peeve today, thrice. twice from local chiropractors and the third from a local orthopedic surgeon.
Where doctors get off prescribing and performing treatments on patient without actually examining them I just don’t know. I mean, how the hell do you know what’s going on if you don’t touch your patient, if you don’t make them bend, tap their reflexes, perform basic neurological exam, vital signs, orthopedic tests or even take a good history?......?
For all you “laymen” out there, Joe Public who puts their trust in a doctor, you should know how it’s supposed to happen (for a musculoskeletal exam)..…
The doctor politely and without attitude, does a consultation and verbally takes your medical history and history of present illness. Based on that, he or she then…
- Takes your vitals. Height, Weight, Temperature, Blood Pressure, Check your Respirations, etc…Although unless I suspect something out of the ordinary, I typically don’t take BP or Resp. Then, basic neurological exam.
- Tap your reflexes, check your muscle strength, check your skin sensitivity and then just for kicks, make sure pathological reflexes are absent.
- Have the patient demonstrate basic range of motion of the part of parts involved.
Perform actual orthopedic tests of the area involved and any related areas.
- Arrive at a differential diagnosis
- Make recommendations for further diagnostic evaluations or consultations to help the doctor confirm his or her suspicions as to any of the more serious diagnosis
- Prescribe a regimen of treatment based on the above.
- Revisit the diagnosis and revise the treatment plan per the results of the diagnostic evaluations or outside specialist consultations.
- Treat the patient accordingly until a noticeable change in their condition, then revise the treatment plan along the way if necessary.
- If no change in their condition occurs, then refer them for another outside consult, even within the same specialty for a second opinion.
- Are x-rays necessary? Sometimes.
- Are MRIs necessary? Sometimes.
- Are neurological tests such as NCVs, SSEP, EMGs necessary? Sometimes.
When are these diagnostic exam necessary? When the results of which are going to confirm your diagnosis for something possibly serious or change your treatment plan.
Unfortunately, many of these diagnostic tests and procedures have become a crutch for many physicians who would rather be lazy and rely solely on the MRI (or other test) for their diagnosis rather than using them to confirm what their exam told them.
Bottom line; If your doctor isn’t examining you and begins treatment, find another one. After all, you’re the one paying and you deserve it.
Afterall, just like politicians, your doctor is your employee. Don't let them forget it or you'll hire a new one.
Dr. Narson is a 2-term past president of the Florida Chiropractic Association’s Council on Sports Injuries, Physical Fitness & Rehabilitation and was honored as the recipient of the coveted Chiropractic Sports Physician of the Year Award in 1999-2000. He practices in Miami Beach, Florida at the Miami Beach Family & Sports Chiropractic Center; A Facility for Natural Sports Medicine.