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‘Pain is not the only problem’: Report of Findings

In brief, the Report of Findings (ROF) communicates diagnostic discovery and the recommended treatment plan to the patient. The ROF is a verbal conversation that explains the characterization of the diagnosis, and the treatment indications. The ROF should be stylized to meet patient expectations and values. The ROF is an effective way to discuss the diagnosis in simple terms with the patient, and the scope of the treatment plan. The ROF is a proposal that the patient can accept or decline.

The ROF has four parts: (1) diagnostic discovery, (2) treatment indication, (3) treatment plan, (4) and patient’s plan.

Part One is diagnostic discovery. Part One of the ROF explains the ‘what-where-why-how’ of the diagnosis, and explains how patient behaviors, lifestyle, biases, and values may have contributed to the diagnosis and occurrence. The ROF includes a brief discussion of the clinician’s careful deliberation and selection of the diagnoses (plural.) These diagnoses should address all of the: (1) symptoms, (2) ADL insufficiencies, (3) employment related problems, (4) inability to do sports, hobbies, and daily enjoyment, (5) emotionality: organic and experiential, (6) personal values and expectations of the patient. Part One should include an explanation for unlikely or rejected working diagnoses, and include relevant differential diagnosis. The discussion of the diagnosis is intended to put the patient at ease, not to scare them. The delivery of the diagnosis should be definitive and complete. Diagnosis is not prognosis.

Part Two is treatment indication. Part Two of the ROF explains the clinician’s recommended treatments, and how the treatments intend to provide: comfort, healing, return to usual lifestyle, re-engagement in sports & hobbies & leisure, and reassurance to the patient. The treatment plan is incomplete if it only addresses patient comfort. Part Two explains the clinical reasoning for the treatment plan, and explains the likely outcomes if there is no treatment. Part Two explains how the treatment plan will work, who will be administering it, where it will be administered, how long it will take, how long the effects will last, and the estimated cost. Part Two explains the risks and benefits of the treatment plan, and the ideal conditions of the treatment plan including patient participation, and what will be done if the plan is unsuccessful, or if the patient chooses to stop treatment. Part Two should provide treatment options that are: (1) not within the scope of in-office care, (2) are conservative & non-invasive, (3) meet specific patient values, (4) sensitive to specific patient economics or social constraints.

Part Three is the treatment plan. Part Three explains the time-line, the interventions, and the therapies. Part Three is an attempt to orient the patient within the vision of the treatment plan; it is an attempt to simulate the various facets, so that the patient can essentially ‘test-drive’ the treatment plan. Part Three explains the accessibility of the treatment plan to the patient to ensure compliance. Part Three is a Socratic platform for questions and answers between patient and doctor. The doctor is able to reassure the patient, and the patient is given time to consider the recommendation, but is under no pressure to make a hasty decision. Chronic, non-traumatic, non-specific low back pain is never an emergency situation.

Part Four is the patient’s plan. Essentially, Part Four describes the responsibilities of the patient to: (1) ready themselves for the treatment plan, (2) to assume the responsibilities of the treatment plan, (3) to be accountable for their participation including accessibility and costs, (4) monitor their progress and report improvements or set-backs to the managing clinician. Part Four represents at least 90% of the success of the treatment plan; endorsing heuristics.

The treatment plan is designed to, at a minimum, re-instate usual lifestyle through recommendations, education, and access to various types of care. The treatment plan can be designed to meet specific patient expectations and values. For example, the treatment plan can address underlying contributors that will not only offer restoration to usual lifestyle, but will improve the chances of recurrence through patient education. Further, the treatment plan can make recommendations to elevate the patient to an even higher experience of living; evolving above and beyond usual lifestyle. A treatment plan is much more than a single prescription, it describes an entire ‘plan.’

The responsibility of the clinician is to address the entire patient, not simply a complaint of low back pain. When the clinician simply prescribes drugs and surgical referral, the patient is denied access to a complete explanation of their health status, and to the many offerings of a successful treatment plan. The failure to provide a ROF is an example that ‘pain is not 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
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