With some degree of regularity I encounter patients with lower back and leg pain who have previously been to other doctors (MD's included). While examining these patients I ask them if the previous doctor did similar procedures.
"Did they tap on your heel with a reflex hammer like I'm doing?"
"Did they test the strength of your leg muscles?"
Frequently the answer is "no." Even in cases with leg pain and numbness!
"The other doctor just asked me to touch my toes and then gave me a prescription."
"The last chiropractor didn't do any of this stuff, he just took an x-ray and started popping my back."
By telling you to take care not to fall into the trap of simply applying your technique to the patient without a proper examination should not take anything away from that technique. A technique or method of analysis was never intended to be all inclusive in the care of a patient!
Asking the patient proper questions can give you important information concerning the presence of arthritic, infectious, or other pathological conditions.
Is the pain worse at rest (possible arthritis), or on movement (subluxation)?
Is the pain constant and dull (possibility of underlying pathology), or is it intermittent and sharp (joint dysfunction)?
If the right questions aren't asked, potentially serious conditions may be passed over.
The standard orthopedic and neurological tests must be administered to determine the extent of the patients problem. It is suggested that a prepared form that lists the tests on a regional basis be used, otherwise it is too easy to forget one of them. Some doctors think they are too busy in their practices to do a thorough examination, however, it isn't as excessively time consuming as you might imagine; and of course your charges should reflect the higher level of service.
A final point that I would like to make concerns saving yourself embarrassment, and possibly a lawsuit. A patient may become hostile toward you after receiving little or no help from you, then being told by their MD that all along they had an extruded disc. In cases such as this you may become the hero or the villain in your patient's eyes; the choice is yours.
Michael T. Haneline, DC
El Cajon, California
Dr. Michael Haneline is dean of undergraduate and graduate studies at the University of Western States and chair of the CHC section of the APHA. Previously, he was the head of the chiropractic program at the International Medical University and before that, a professor in the department of research at Palmer West, where he also taught courses in evidence-based practice.