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A Patient Filed A Complaint! | Wednesday Checkup | Doctor Mike

Jun 14, 2021
hey guys welcome to a new episode of

wednesday

checkup

today. I will share the story with you. It happened a couple of weeks ago where unfortunately a

patient

filed

a

complaint

against me which made me very emotional. Let me tell you why before I start I want to let you know that I am going to change some details about the

patient

just to keep this person's privacy and not make anyone feel uncomfortable because that is not the goal of this channel, our job is to keep us happy and healthy . learning about ourselves learning from our mistakes and that's what we're going to do with today's story here we go let's start setting the stage I'm working in my outpatient family medicine practice and I see a patient on my schedule I have the demographics that he is a man who is almost 20 years old and also the

complaint

or the reason for which he made the appointment the patient would like an MRI for low back pain the patient comes to my infirmary the patient came in and we started to have a conversation the story of the current illness is as follows the patient is over 20 years old the man works long hours at his job as a salesman in a department store where he is on his feet he has been complaining of low back pain for an extended period of time he is sometimes improving sometimes actually he's not in a lot of pain somewhere like three to five out of ten, sometimes it gets pretty bad, going up to an eight, this p The patient has had previous back surgery, we don't really have a clear understanding of what the surgery was and what the indication for the surgery was but we do know that back surgery was performed and my first question is because my goal is to help the patient and answer directly to the patient's question if you told me or at least told my nurse that you would like an MRI What are you looking for to find out what is MRI?
a patient filed a complaint wednesday checkup doctor mike
He wants an MRI because he is concerned that the activities he does in his daily life may be causing more damage to his lower back and that perhaps there may be scar tissue from the previous surgery or perhaps something else is going on inside of him. your lumbar or thoracic spine that could be causing your symptoms. Originally scheduled, the visit was supposed to last 15 minutes, which is normally what we get for an acute visit, but I said we'll spend more time because I really want us both to be on the same page and especially since I've never seen you before.
a patient filed a complaint wednesday checkup doctor mike

More Interesting Facts About,

a patient filed a complaint wednesday checkup doctor mike...

I want to create a little relation before giving any kind of advice or guidance one of my first questions being a sports medicine trained osteopathic

doctor

was do you do any kind of physical activity and how does it affect your back pain which he told me every morning or almost five days a week you do calisthenics in the morning for about half an hour and you can do them without pain and you actually get a lot of benefits from doing this calisthenics. isthenia and stretching also at least once a week you walk eight nine miles after the eighth or ninth mile you start to develop lower back pain that makes it uncomfortable for you to continue and you have to cut your walk short?
a patient filed a complaint wednesday checkup doctor mike
What should i take? as a

doctor

of that kind of information first it shows me that this patient is very functional he can do stretching he can do complicated and compound movements he is not incredibly limited by this back pain which was a good sign for me because as a doctor my job is always to get my patients to move especially when it comes to low back pain there was a misconception in the past that if your lower back hurts you should rest that is actually quite inaccurate because what I found is that the more time you spend in bed with low back pain, the worse it can be now.
a patient filed a complaint wednesday checkup doctor mike
This was the first time I had seen the patient, so I asked what was going on in my patient's life. He described a very stressful life, especially when it comes to work, he works long hours of 12-14 hours sometimes and the back pain worsens after being on his feet all day and sometimes the patient even began to crying because he was so upset about stressors in his life with family friends there was a lot of things going on but I could see that stress was a big component and there was a big mental component to this pain so after getting the full history and what was going on with his back pain, i did a physical now the patient's physical i had some muscle spasms, raise your leg straight up, which is the test we do to check if the sciatica was actually negative, which is a good sign that means the sciatic nerve is not involved in this type of pain.
I did a few other challenge tests and all went well. Negative there were a few tender points I got but nothing really concerning no bone tenderness reflexes were fine those are important things we rule out when looking at someone's back pain so once I did the proper history I did the full physical exam. So I decided to explain to the patient my thoughts on whether or not he needs an MRI. I told the patient that an MRI would not benefit him because what we find on MRIs does not. It doesn't always translate into clinical symptoms, in fact, most of the time there have been no studies in the past where we scanned a hundred people who didn't have back pain and found that on the MRI they had significant findings, arthritic changes and degenerative changes. bulging discs but these patients didn't have back pain so what does that tell us that telling us that just because you have an MRI finding doesn't mean it will have clinical significance and as a doctor it's not my job to treat the mri, is to treat my patient, so i told the patient that based on how functional he is, based on my physical, knowing he can do calisthenics every day, walk charging miles, i can barely walk eight miles without pain His back seemed to be more tied to his stress levels at work now, that's not to say my patient doesn't have a real medical problem and it's caused by tender points; they're describing the pain, which is a subjective measure, but they're describing it and they're saying how uncomfortable they are, so it's my job to fix that, so what I explained to the patient is that I thought he might benefit from conservative management, specifically physiotherapy.
I also recommended some osteopathic manipulation and gave him a reading recommendation. Material on the conditions of the mind and body where, depending on our mental state, some physical problems can arise, such as low back pain. As a primary care physician, it is my job to delay the process of risky procedures as long as I can, as long as there are no urgent matters. I didn't see an MRI as the right next step, but I understand that some patients may have reservations about it. I understand that you may have anxieties about your back pain. eg why is it there?
I'd like to see him better, so I explain to the patient that if he doesn't agree with my assessment or thinks he still needs an MRI after this discussion, I'd be happy to write him a prescription. for an MRI and we can start the process or I would like to see you back next week so we can continue this conversation he would have already started physical therapy and had a couple of sessions and we could see what progress you are making and if at that point you decide you want write, I'll write you the MRI and then I'll write you a referral to a specialist if that's what you want and my patient seemed to be very understanding doctor I appreciate you taking the time I see what you're saying I don't want them now I'm listening I'll see you next time This week I will start physical therapy and we will go from there and he was very proud of me as a doctor it is not always easy to have a patient who wants something and it is your job to convince them for their own good or at least their medical opinion for their own good that it's not ideal what they want and that there's a better way and for them to understand that and be on the same page that takes skill and sometimes it takes doctors a long time. many years to develop that skill.
I returned the following week to my hospital. A patient called and left a complaint with our office manager. The complaint was basically this: The doctor I saw did not help me with my pain at all. this doctor was too spiritual and i would like to see a real doctor who is willing to help me with my pain it was something like that im paraphrasing the rest of the day i was left feeling like i did better what did i do wrong where did the communication break down so i started replaying the situation over and over in my head trying to figure out what i can do better how i can improve and something i do is ask people who are more experienced than myself or people who are experts in other fields for their advice , so I want to go see one of our behavioral specialists that works within our office and basically what he told me is that there are some patients, which is a small percentage of patients like less than 10% even less than 5% probably the more care you give them the more time you spend with them the more effort you try and put into explaining something the more they take away something negative why this doctor is trying to tell you e sell me What is this dog?
Is he trying to outdo me on this? writing and just being very buttoned up, well, he wants an MRI. I don't think it's in your best interest to have an MRI and say you know, if you don't disagree with this, here I can give you a referral to see a specialist. another doctor or the test you really want ordered what it taught me was that at certain times with certain personalities it makes sense to be shorter and more succinct than just explaining things clearly rather than trying to sell and influence that person because they may seem manipulative for some people cannot blame himself for everything the situation could happen due to an unfortunate coincidence if you will the fact that this patient never met me i never met the patient i tried to be very nice the patient misunderstood that for some reason the patient

filed

a complaint, but people who know me, nurses and other patients will understand that my intentions were good. then look at the results if the intentions were bad now we know that person needs some work on that end of the spectrum if the intentions were good but the results were bad then we need to work on the action and figure out what we need to improve on that action I want to continue learning as a doctor and i feel like we can learn together throughout this unique journey of mine i think that is even more special and that is why youtube was created talking about good intentions and bad outcomes watch my mental health video here stay happy and healthy and i will see you in this video

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