April 10, 2019: This ID provider was having some trouble with a difficult case. He was questioning if his patient had a thoracic disc problem… or cervical disc… with a shoulder problem??? We use the ID system to go step-by-step, dive deep into the fundamentals and stay on track until we reach an answer.
Lessons from this coaching session:
Have a sclerotome chart available for reference
Use the chart to compare with your pain diagram
Understand what the dark vs light areas indicate
SLOW DOWN: Follow the ID system, step-by-step.
Be prepared to spend 30-60 minutes to dissect your difficult cases.
This will become much faster, but it always starts off slower
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I learned so much from this case. Thanks Brandon and Dr. Brady for taking the time to share this and break it down.
When you are communicating the ROF to this patient, what terminology are you using when explaining to him that he has a problem in his thoracic disc complex. I know you discussed what to say once you got rid of the adhesions but I am more curious what to say on the initial. Can we include load management advice on the initial ( I know we try to avoid this and clearly this is a case where he needs it but also hitting him with all that at once could cause him to be overwhelmed and not process the diagnosis).
Do we keep it really simple like: “The disc and bone in your spine are damaged and can’t heal because they are in an unhealthy environment…(then explain adhesion and discuss load and how we need to fix both of theses issues) Bone only heals with rest, you wouldn’t expect a broken arm to heal if you kept using it, same applies for the bone in your back.”
That’s perfect! Your simple explanation is exactly the place to start. Then answer questions if there are any. If he shakes his head “yes” and says “alright” then move along with your ROF. Remember it’s like a dentist explaining you have a cavity-simple.
Be a little careful with the broken arm analogy, it’s good, but make sure they don’t perceive their “back is broken” but rather this is a small hole/defect/area of compression/etc. Show them a google image of what it looks like if needed. Thanks
This is a great video, I learned a lot from hearing the thought process in explaining the symptoms. The commentary around sclerotome interpretation was also very helpful. In school we were rushed towards giving a diagnosis which very likely wouldn’t involve endplate fracture. This is another great example about the importance of slowing down to consider the data.