The most important aspect on the first encounter with a low back pain patient is to build the best possible relationship. The best relationship is best described as a respectful interaction with the entire patient including their values and expectations, on their terms. This is termed the ‘Patient-Doctor relationship.’
The second most important aspect on the first encounter is professional manners and procedures. The doctor-physician-clinician is expected to represent all medical professionals with an example of excellence; acting in a manner that exemplifies the pursuit of science and all human well-being, and to never do harm. Professional manners imply clinical reasoning instead of dogma or routine. The clinician is motivated by early and accurate complete diagnosis, and complete treatment success at low cost, and with complete patient satisfaction (perpetuated satisfaction.) Professional procedures imply a clinical experience that bestows reassurance upon the patient; the clinician offers the expected Standard of Care established by the industry, not by laziness, lateness, personal bias, financial gain, standardized practice, or ego. The clinician appears to be accessible, introduces relevancy, offers empathy, comfort and optimism on behalf of the patient. The patient feels welcomed and important. The clinician offers an ‘entire experience’ for the ‘entire patient.’ Trust is established easily.
The third most important aspect on the first encounter is establishing a complete diagnosis that exemplifies the entire patient at the point-in-time of the office visit; clinical reasoning completely explains the contributions and causes for the patient’s complaint and incidental findings. The clinician is diligent enough to explore beyond the obvious symptoms; to identify underlying habits, lifestyles, diet, biases, and beliefs of the patient. A diagnosis of pain, and the treatment of pain is never the only problem.
Finally, on the first encounter, the clinician makes a wholehearted promise to endure the Course of Care on behalf of the patient’s well-being; the doctor will maintain a robust, kind, and accessible relationship with the patient. The patient will experience advocacy, knowing that their health is in good hands. The clinician offers a personal guaranty and promise to deliver the expected results.
‘Game Day’ describes a vision for the promise of real care. Game Day establishes the highest possible standard of care for a profession that seeks to gain the confidence of the public.
The failed model known as ‘Health Care’ is a ‘for-greed’ business model that stigmatizes an already crumbling for-profit corporate hubris that serves only share-holders; wellness is never achieved since the insurers manage ‘covered’ types of care, leaving clinical experience and expertise for dead. Instead of calling the health care system ‘broken’, let’s call it ‘crooked.’
Care should not be considered as ‘affordable’ based on the cost of insurance rates, it should be affordable on the terms of ‘paid in cash’ directly to the clinicians that provide the services. When clinicians can perform their duties of service to their patients, 95% of all sickness, un-well-ness, and disease is eliminated simply due to lifestyle improvement counseling. Insurance is reserved for incidental trauma and un-preventable disease. The current insurance model includes sickness that is preventable and also ‘premium-able.’
The Game Day approach attempts to identify LBP patients through the lens of lifestyle contribution and lifestyle modification. When the clinician’s prescription is lifestyle change and body-use modification, offerings like addictive drugs, invasive surgeries, and risky injections fade… and the costs associated with them fade… it costs NOTHING to the patient nor the clinician to identify FMP, or give advice for lifestyle change, or to provide optimism and motivation.
The Game Day approach works exactly like sports performance… give your due diligence, train for results, be optimistic, be a team-player, and listen to your coach. LBP patients complaining of non-specific, non-traumatic, episodic symptoms, and without progressive neural deficits represent nearly 100% of all LBP office visits, and is the #1 reason for a visit to the doctor. A visit to the doctor’s office is no different than an athlete seeking guidance from their coach. Clinicians are coaches… so are doctors and physicians… coaches with guidance, with optimism, and with solutions. Coaches don’t want to be behind a losing team. If your patients are not 100% satisfied, then you are coaching a losing team. Athletes don’t want to wait for results, they want to get back in the game today. Clinicians should be using same-day solutions, not delaying diagnosis and floundering in their own confusion. Confused coaches are losing coaches.
The Game Day approach assumes that the patient has a functional disability related to how they use their body at work, at home, or with activities or hobbies… consider use of ‘commission’ and/or ‘omission.’ The clinician focuses on sub-clinical disabilities related to the STMT model already discussed. The STMT is evident in a complete history with exam. The patient history is equivalent to an athlete’s training program; the way the patient lives and behaves is a training program… train for function, or train for injury. Athletes believe in winning, and want to win. Patient habits, biases and preferences will expose their desire to resolve their complaint. Social, economic, cultural and emotional contributions are easily related to the complaint. Multi-system examination and work-ups expose pain generators. Differential diagnosis explains possible somatic mechanisms and functional limitations. The Review of Findings proposes clinical evidence the Course of Care.
When the LBP patient is disinterested in a compliant program for lifestyle and behavior improvement, or does not respect the clinical reasoning for conservative care, the clinician must continue to advocate for the patient. Certain patients believe that it is the accountability of ‘outside forces’ to ‘fix them.’ However, if the patient is willing to comply, make certain that your clinical program will facilitate a ‘walk-though’, have specific milestones and goals, a workable schedule, check-ups & check-ins, be accessible… most importantly prove efficacy at low cost. If you can be a good clinical-coach and your patients want to win, Game day is good as gold.
Game Day, as a clinical concept, is a metaphor for the dedication and determination that athletes embody in order to reach the successes of performance ‘wins.’ LBP patients are no different. They want to win, and they can, when they understand that ‘pain is not the only problem.’
LBP Blog General information
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. www.preformancecxs.org
© Copyright 2021 SpineSync, Forester Dean, DC
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