Symptoms vs. Treatment Plan

Report symptoms; don’t propose a treatment plan.  That’s one rule of obtaining good medical care that’s quickly apparent when reading medblogs.

Knowing that’s how doctors feel, and having an excellent family physician who I don’t want to annoy, I was a bit hesitant to phone my doctor’s office and give my reason for visit as “I need a cortisone shot,” so I followed that with, “But if you want, you can just say ‘shoulder pain’ and let the doctor determine that I need a cortisone injection.”  That earned me a laugh and the comment, “It sounds like you’ve figured out how things work.”

The way it’s supposed to work is that patients report symptoms, then doctors consider those subjective symptoms as they decide what type of exam to perform and determine whether it’s necessary to order any tests.  This generates objective data.  Doctors then assess the information to develop a treatment plan.  The entire process is carefully documented in a SOAP note (another SOAP explanation; real-life example).

When I called the doctor’s office, I’d hoped that there would be an appointment available early next week, but by a huge stroke of luck, I got the office manager on the phone instead of my doctor’s brand-new receptionist, and was offered a same-day appointment.

Once in the exam room, I explained to the nurse that my rheumatologist offered to do a cortisone shot at my two previous appointments, but the first time I didn’t think it was bad enough, and the last time I said yes, but then she got busy confirming that other pain was costochondritis instead of a need for a cardiology referral and she didn’t do the shot in my shoulder.  I’ve been living with it, but it’s getting worse instead of better.  It hurts all the time, and I have limited range of motion that interferes with my ability to demonstrate various strokes to the kids in my swimming classes (it also interferes with my ability to dust the top of my refrigerator, but I don’t mind that nearly as much).  Constant pain is something I’ve learned to live with, but I need to be able to swim.  I doubt that I’ll ever do the butterfly again, but a basic crawl stroke is a must.  Also, it would be nice to be able to play my guitar again.  This is interfering with my life.

My doctor always reads the nurse’s notes before entering the exam room so he knows what he facing.  This time, as soon as he walked into the room, he asked, “Do you want a cortisone injection?”  It was sooooooo nice to get right to the point!  Of course he still did an exam and documented the limited range of motion, the crunching sounds, and all the rest, before giving the shot, but it was more along the lines of, “prove the patient right” instead of being treated as if I know nothing.

I like the fact that my family physician is thorough about doing an exam.  Documenting the extent of the problem and finding the most appropriate treatment is important.  The fact is, maybe I don’t need a cortisone injection.  In the past, these symptoms have led to a shot, but that doesn’t automatically mean that’s what’s best this time.  There might be a different problem, and it’s good to not make assumptions.

I’m not very appreciative when people with no training tell me how to do my job, and it’s no surprise when others – including doctors – feel the same way.  It was nice to discover how easy it can be to stick with describing symptoms, reporting facts, and letting my doctor determine the best treatment plan.

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2 thoughts on “Symptoms vs. Treatment Plan

  1. Loved your post. I tend to be “an active participant” in my healthcare process — which means I have an opinion. When I saw my ortho guy earlier this week they asked me my standard question, “Hips or knees?”. I replied that I was hopeful to have my left knee injected (which after his evaluation, he agreed that was a reasonable treatment for the situation). At the end of the appointment, he started to tell me to come back in a month then told me that I knew if I needed to be seen again or not.The fact that we can have a relationship with our doctors where we respect each other’s roles — and intelligence — and can have a meaningful dialog about the course of treatment is a wonderful thing and a real blessing for those of us with chronic illness.

  2. Thanks for the very helpful post about your skills in meeting your life goals (swimming) via effective health care use and relationships. This is instructive for those who are still developing the relationships with their physicians and office staff. Thanks for the link to “Prove the Patient Right”. That strategy has been helpful and fun for me and my patients for a long time.

    The patient pain and fatigue factors add degrees of difficulty to caring for those with RA, so the need for an effective relationship becomes more important. Your use of humor with the office staff also helps them to feel less stressed while trying to help you (and please/protect the doctor).

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