Skip to main content

‘Pain is not the only problem’: Course of Care

The first encounter establishes the expectations and values of the LBP patient. The clinician must be keen to respect and protect them thorough the entire Course of Care. Building the best possible relationship between the patient and the doctor requires re-framing the accountabilities of the patient, and the virtues of the clinician.

Historically, patients have been ‘taught’ to rely on their doctor to remedy their health problems; doctors are Gods that ‘do no harm.’ Historically, doctors have been ‘trained’ to represent superiority; paragons of medicine and the apotheosis of the health-sciences. Historically, the patient has been the victim of the doctor’s reign; powerless to question or make choices in care options, rather, settling for routine treatments that are ‘sold’ to them without explanation of risk, harm, or cost. In other words, medical ego has commanded superiority over patient values. Because this dynamic perpetuates, real relationships can’t exist … unless an alternative platform is available.

With an alternative platform, the first encounter can empower the patient to control their Course of Care, and steer the clinician’s duty toward personalized care. The Course of Care should define the needs and requirements of the patient… an educated and empowered patient that does not bow down to medical omnipotence. The patient is in complete control of their care as defined by their personal expectations and values that is affordable without involving ‘insurance.’

This alternative platform is a ‘systems design’ model in which the inputs, thruputs, and outputs are defined by the patient (the user), affording patients and clinicians an option to the broken, for-greed insurance-manipulated model. The idealized ‘health care system’ is renamed the ‘business of sickness.’ The proposed systems design is constructed to match patients and doctors that intend to focus on accountability, affordability, and creativity to resolve the most common clinical complaints, such as LBP. 

Course of Care definition: a proposal for the entire duration of the treatment plan that includes resolution of the Problem List using an agreed strategy involving primarily patient contributions, along with the clinician’s ongoing conservative coordinated-care advice, with a personal & professional warranty that the best outcomes will be made possible with the most economy of the patient’s time and finances, and at least risk to the patient.

The Course of Care begins with clinical reasoning to establish the care plan, and ends with clinical reasoning that explains the expected outcomes… this is the essence of a systems-based model. A non-systems-based model begins with medical ‘anything’ and ends with medical ‘anything’, and in both cases no explanation or accountability is offered… this is the essence of medical guessing. Medical guessing involves medical magic. The medical clinician offers a medical procedure that seems complicated and impressive, yet no promises of accountability nor promises of results are made nor implied. Instead, the clinician confounds the patient with the sales pitch that ‘price-tag and complexity’ equals results, when in fact, conservative care could have provided better results the same day at very low cost, and without risks. 

Appropriately, the Course of Care begins with clinical reasoning and a complete diagnosis that the patient understands and agrees with, and important differential diagnosis are discussed. The clinician initiates a commitment to patient advocacy while promising swift results at low cost. The clinician offers an entire experience for the entire patient. The clinician discusses all important contributors to the patient’s LBP, including sympathetic amplification, diet, and personal biases. The clinician explains the goal to establish spinal stability by explaining its definition and the pathway to achieving it. 

Certain LBP cases require an emergency/911 approach; the patient presents with unrelenting pain not due to known trauma nor underlying disease. These cases require immediate care to abate pain and restore function. Conservative care can provide impressive instant results*. Once established, a return to functionality and performance dominates their Course of Care. The most important prescription is brisk walking 10-20 minutes even with pain to re-establish sacral motion on the same day, and everyday upon waking without interruptions. On the same day a multi-planar active range-of-motion drill series* re-establishes ‘spinal segment coupled motion.’ After 3 days, the patient explores hip mobility and explosiveness*. Finally, the patient explores axially-loaded CORE reactive drills* in multiple planes on command. This program is at least 100% effective with excellent patient compliance*.

When the clinician focuses on ‘pain only’ there is no hope for patient satisfaction, and medical trust decays. A complete Course of Care is able to provide swift results and re-establish daily activities…  and even improve the base-line spinal stability and patient awareness and accountability. ‘Pain was never the only problem.’


LBP Blog General information

Series Description

These articles intend to (1) re-evaluate the prevailing clinical practices thought to manage low back ‘pain’, (2) submit and debate novel low back ‘pain’ contributors and mechanisms, (3) meet patient expectations & satisfaction and clinically meaningful results, (4) recommend a conservative non-surgical course of care to over-ride ‘pain’ instantly, and (5) restore ADLs and patient confidence on the first visit at low cost. This article has a companion podcast.

Dr. Dean Bio

Forester Dean is a chiropractic and physiotherapy sports medicine doctor practicing in Los Angeles, California. Dr. Dean is a lifetime athlete, and currently teaches tennis, track, boxing, yoga. The Core X System™ Campus flagship location was opened by Dr. Dean in 2020.

© Copyright 2021 SpineSync, Forester Dean, DC
Duplication with permission only

Leave a Reply