By: Dr. Michael Cerami January 2018
As patients become more involved in their health care choices, they predictably want more control over their choices and their health care. Starting a journey with a new doctor can be a bit intimidating; they’re a lot of unknowns. Most important in the patient mind is “How soon until I feel better?” As a physician, I’m hopeful doctors take a step down from their authoritarian role and try to remember what its like when they get to be the patient. If we’re honest, we have the same questions and are just and impatient. This is what I call the “Dr. Jekyll and Mr. Hyde” relationship.
I recognized this years ago after I had a sports injury. I caught myself thinking “Yeah its better, but when am I going to be ALL BETTER?!” This was a huge contrast to being on the other side of the equation as a physician and silently wondering “Why aren’t they happier that things are improving…??” I laughed at myself and quickly realized that when we’re hurting, we all get demanding. It’s normal, it’s human. The question is, how do we get both the doctor and the patient to move a bit closer to the center so that both parties can be a little more understanding?
I believe one way to do this is by making sure the physician or provider keeps the patient regularly informed of their progress with metrics or measurements of improvement that make sense to the patient: that the patient can feel. In our office, we always start with measurable goals that are important and are part of the patient’s life. These can include: “I want to be able to work at my desk without back pain”, “I want to run 4 or more miles without my knee hurting”, “I want to have less than 4 headaches every week”, “I want to be able to exercise at my Pilates class and not hurt the next day”.
In order to be successful as an office, we need to see improvement from the patients goals as well as improved measurable examination goals (better motion in the spine and hips, muscles that are not activated, equal legs lengths and more). The doctor’s goals and the patient’s goals in this way can be different but they must both be achieved in order to have success. Getting symptomatic change without functional improvement means the problem is going to come back. Seeing functional changes, without symptomatic improvement, means the patient is still in pain. Neither of these is an acceptable outcome in my opinion.
Finally, the doctor and patient should agree on when and how often to check in with the clinical progress. At Utah Sports and Wellness we do a progress review every 6 visits to confirm that we’re on target and getting improvement. Look at it this way; if you hired me to drive you to Los Angeles, more than likely, we’ll need to go through Cedar City, St. George and Las Vegas. If you’ve never taken the trip, it would probably be a good idea to check the map on a regular basis to make sure you’re passing through those towns to confirm you’re headed where you want to go. If you don’t check in often enough, you could be in Boise and have wasted a lot of time and money going in the wrong direction.
I encourage all patient to be better “health-care” consumers and hopefully the doctors can keep up.