An old story about a frog trying to escape from a well has left us with the phrase, “Two steps forward, one step back.” As evinced by this tale, when progress is made, it is often a companion to some type of regression.
This adage can be applied even in the field of medicine. The modern era of healthcare has brought MRIs, CAT scans, fluoroscopy, and the implementation of a digital medical history database accessible by doctors anywhere. But with those improved methods has come a detriment as well, argues Dr. Ramsin Benyamin, founder of Millennium Pain Center in Bloomington.
“What is currently missing in healthcare is nobody has time to listen to the patient—time to spend with the patient,” Dr. Benyamin says. “Everyone is rushing, rushing, rushing.”
This is not the fault of the doctors, he adds. “The primary care physicians are under pressure to see up to 40 patients a day and at the same time do the electronic documentation—almost an impossible task if you want to really be thorough.”
At the heart of being thorough with a patient, of course, is being able to properly and accurately diagnose what is wrong. And diagnosis influences everything. “Not only is there a poor choice of treatment based on poor diagnosis or no diagnosis, but it’s also a waste of money,” the doctor says.
Many improper diagnoses are made because of one major step back: “Doctors are treating the picture, rather than the patient,” Dr. Benyamin states simply.
The doctor sees many patients suffering from pain, but when they come to him, they often feel they already know the source of the problem. “‘I have two disc herniations and one disc bulge,’ they say,” the doctor gives as an example. But their understanding of the problem comes solely from something like an MRI scan. “They have been told the source of the pain is based on the picture. There is no objective way of evaluating it; no effort has been made to do that.”
The value of the MRI has its limits, Dr. Benyamin points out. “Just because the MRI doesn’t show it doesn’t mean there is not a problem. And the other way around as well—just because the MRI shows something, it does not mean that is the problem.”
The doctor adds that unfortunately, “what determines the course of treatment is usually this picture rather than a thorough examination of the patient. If the report says ‘herniation,’ the patient ends up in surgery. If it’s a disc bulge, they end up in physical therapy.”
When neither course of action seems to solve their problem, they come to pain specialists like Dr. Benyamin. “I can’t tell you how many times I have seen a patient come in after they have done all kinds of physical therapy and taken pain medications, and now they are here because of a referral.”
It is a direct result of people “shooting in the dark,” he explains, “and not focusing on diagnosis first. When treating back pain, I think it’s very important we focus on diagnosing the source of the pain and then offer treatment modalities—physical therapy, for example.”
“Don’t we all do that in our daily lives?” Dr. Benyamin asks. “Don’t we, when we face a problem, try to find the source of the problem, and then we solve it? We don’t just throw darts.”
The doctor advocates proper diagnosis as essential before treatment modalities should be put into effect. After all, anyone who suffers understands treating their pain should not be a game of darts.
Read “Simple Steps for Proper Diagnoses, Part 2” in next month’s issue of Healthy Cells to learn the important role patient history plays in proper diagnoses.
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