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Education

Chasing Pain- Waste of Time and Money

Emilio Galis P.T., D.P.T
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In today’s healthcare climate,  it seems that the majority of medical practices are spending less and less time with their patients. Higher deductibles and co-pays, but fewer minutes spent with the patient. When a physician does not take appropriate time to thoroughly examine patients, misdiagnoses occur. This leads to mistreatment, longer time spent treating the issue, and more healthcare dollars spent. This scenario happens far too often.

Imagine this:

You notice a light bulb is out in the lamp in your living room. You change the bulb – but the lamp still doesn’t work . So you try a different light bulb – it must be the light bulb, right? Try another light bulb. You are still in the dark.

But then you notice, the clock is out on the oven and the fan isn’t running. You check the breaker and flip the switch – and suddenly you have light again. It was never the light bulb- even though that was your first clue that something was wrong. You very well could have decided to unnecessarily spend money to change out a good functioning lightbulb without recognizing the breaker was the stemming issue.

Throughout the course of my career I have had countless patients walk through my door with a prescription that says something like “shoulder pain/rotator cuff tendinitis” or “hip pain evaluate and treat” and the body part identified had no root cause of the issue at hand. When someone points to their pain saying “my shoulder hurts” or “my hip hurts,” that doesn’t necessarily mean that’s where the issue is stemming from. Too many medical professionals have decided to “chase pain” which is the notion that the location of pain is the source of the problem.

Through a thorough examination with adequate time spent ruling in and out root causes, a medical professional can identify the issue and then treat it more effectively. Take for example the 55-year-old office manager coming into the clinic with a prescription that reads “Shoulder pain Evaluate and Treat”.

Physical therapist diagnosing patient with painful armThis patient has significant shoulder pain that burns and radiates from the front to the back of the shoulder and it gets worse when she is typing on her computer for hours at a time. Maybe the doctor spent 4 minutes looking at her and diagnosed her with a shoulder issue. Maybe no questions were asked about her pain- What type of pain? Where is it located? Does it travel down your arm? What are you doing when the pain comes on? Etc. If we just started treating the shoulder as if it’s the root cause of the pain before ruling out anything else, we may spend the next 4-6 weeks doing absolutely nothing to benefit the patient. Now the patient has spent 360+ dollars in co-pays for wasted time, not to mention gas money and time off of work to get rehab. This is the reason it is so important to do a thorough examination and pinpoint root causes of the pain.

In this example, if we would have ruled in/out neck involvement we would have a tremendous chance to get a breakthrough in treatment. Let’s say we detect that your shoulder pain comes on with certain neck movements or compression of the cervical spine. Maybe there is tight muscle around the neck that is causing compression to nerve roots coming out of the spine? Perhaps there is a disc that is protruding in the spine that is giving the nerve coming out of the spine some irritation. This could be why the neck range of motion is very limited.

One thing to keep in mind is that our extremities are innervated by the nerve roots coming out of our spine, and the way our muscles fire and the sensations felt in our extremities have everything to do with the nerve roots coming out of the spine. If there is some disruption in the communication from the nerve root to the muscle controlled by the nerve, then we would expect that muscle to not fire properly, fatigue faster, go into spasm, develop tendinitis, hurt, and possibly have some swelling.

 We can work on that muscle alone all we want but if the communication between nerve root and that muscle isn’t changing, then most likely the problem isn’t changing. It goes back to our analogy when you decided to change out a good functioning lightbulb because the light wouldn’t turn on, but you never checked the breaker box first to see if that’s why the lights weren’t turning on.

In this example if we find in our examination there is neck involvement and treat the neck alongside the shoulder, your rehab time just got a lot shorter and you saved money too! You also don’t have to deal with the pain for more weeks, months, and potentially years. And even worse, if that problem went undetected for too long, one would be more susceptible to weakened shoulder tendons and be susceptible to tearing, and subsequently more susceptible to surgery and again more rehab. It’s a domino event that could have all been prevented if time was spent on that first session with a comprehensive evaluation/examination. This domino event unfortunately happens every single day in the current healthcare climate and is part of the reason there are billions of wasted dollars. Don’t be one of these statistics!

I am proud to work for Legacy Medical Centers, a company that does NOT fall into the healthcare norm of pushing patients through the doors like a factory. Adequate time is spent with each patient 1-on-1 so that every patient receives the most accurate diagnosis, and subsequently, the most effective treatment. Each treatment plan is individualized to the patient, their specific needs, and goals. There is nothing cookie cutter about it. Every patient deserves quality when it comes to healthcare.

Keep in mind that all of Legacy Medical Centers physical therapists have direct access licenses that allow patients to be evaluated without the need of a prescription from a physician (except for Medicare).

Thank you for taking the time to read my blog and I wish you nothing but great health and wellness for years to come.

Emilio Galis D.P.T treats physical therapy patients at Legacy Medical Centers Irwin location. Physical therapy is available at all three Pittsburgh area offices.