“Listen to your patient; they are telling you the diagnosis”
I stumbled upon this quote early on in my physical therapy career, possibly even while I was still a physical therapy student, tucked into our curriculum by one of our wise professors. It has always stuck with me.
The man responsible for these words is Sir William Osler, a 19th-century physician and one of the four founders of Johns Hopkins Hospital. He was the creator of the first medical residency programs — residency — you know, the thing that every physician coming out of medical school must do to become a legit physician these days.
Before Sir William Osler, folks could become doctors by simply sitting through medical school in lecture halls; no direct patient experience was needed (!!) What!?
So, to say we owe a lot to Sir Osler is an understatement. He placed a high value on seeing, listening to, and talking to patients. He knew this was the path to becoming an effective clinician. Today, we would call this “taking a thorough medical history,” at a minimum.
As most of the medical world shifts towards using technology to maximize efficiency, here at SchrothDC, we’ve taken a different approach. We book extra time for every new patient coming through our doors: a full 80 minutes. We felt this was necessary after years of squeezing an entire evaluation plus treatment into a 45–60-minute time slot, as most physical therapists are instructed to do.
Don’t get me wrong; technological innovation has been wonderful for us in some ways. Thanks to our wonderful software, our patients love the ease of booking and adjusting their appointments online 24/7.
But our ability to sit down with every new patient to discuss their scoliosis diagnosis, interventions that they’ve had, symptoms, past physical and emotional trauma, limitations, and goals — this is gold. And this takes time.
We listen, digest the information, and form a hypothesis about the generator of their symptoms and how we can best help them.
Why is this important?
Albert Einstein said, “If I had one hour to save the world, I would spend 55 minutes defining the problem and only 5 minutes finding the solution.” The best solution is 100% dependent on knowing what the problem is.
Let’s examine a common symptom patients come to us with: pain in the outside of the thigh.
Because we know our patients have scoliosis, many of them in the lumbar spine, it can be easy to jump to the conclusion that the L5 nerve root is being pinched due to scoliosis and what is deemed “the fractional curve” (more on the fractional curve later — that deserves its own blog post).
The dermatome, or part of the skin innervated by the L5 nerve root, is the outside of the thigh. However, if we dig deeper, ask a few more questions, like:
Caroline: “Do you ever get pain below the knee?”
Patient: “No, never.”
The L5 nerve root innervates the skin all the way down the outside of the shin and into the foot. If the L5 nerve root were truly compromised, the patient would have symptoms in their shin and foot.
Caroline: “What is the nature of the pain: dull/achy/throbbing versus sharp/shooting/stabbing?”
Patient: “Throbbing”
Nerve pain is typically sharp, shooting, and stabbing pain.
Caroline: “What relieves your pain?”
Patient: “Tylenol”
Nerve pain is intense and often requires prescription anti-inflammatory meds, medications specifically for nerves, and, at times, opioids to relieve it.
After this conversation, my mind pivoted to a different diagnosis, one that is more muscular, such as IT Band Syndrome, in which the IT Band on the outside of the thigh has become overly taut and hypertonic due to a lack of lateral glute strength on that side and subsequent overuse of the tensor fasciae latae (TFL) muscle. (The TFL attaches to the IT Band)
As you can imagine, the treatment for L5 nerve root compression differs greatly from IT Band Syndrome, so it’s imperative to know the difference.
There is so much to be said about the state of our current medical system:
Not enough doctors
Doctors are being backed up due to Covid
Decreasing reimbursement from insurance companies
The list goes on and on about why our medical professionals often have less than a few minutes per patient. This can be incredibly frustrating. It can leave one feeling lost, uncared for, misunderstood, or even despondent.
We'd love to work with you if you’re ready to be seen and heard and solve the puzzle of your scoliosis and associated symptoms. We believe in taking care of our patients as if they were family, not only prescribing exercise but also advising them on all things scoliosis-related: bracing, surgery, bone health, etc.
Yes, we do ask a lot of questions. Our curious minds are information gatherers. We’re truly interested in every “case.” Perhaps this can be the new barometer of an invested clinician, someone who’s willing to find the answers hidden in plain sight.