I was once a Boy Scout, living in a Boy Scout world and learning Boy Scout things. So I learned about snakes, and how to tell a poisonous one from a non-venomous one. But one sneaky snake is the poisonous coral snake, which looks like the good-guy corn or scarlet king snake.They both have red, black and yellow "rings" on their bodies, but in different variations. To differentiate these reptiles, I learned the following rhyme about their rings: "Red touches black, friend of Jack. Red touches yellow, kill a fellow!" Somehow, this seemed important to a 12-year-old boy in central Illinois, with the closest coral snake about 1,000 miles away in Florida.
I don't have a jingle to remind me of how to tell the difference between the patients who want to know what's wrong and the ones who just want treatment. My older chiropractor brother figured out years ago that is was important to differentiate these two types of patients because they have different expectations. It's a lesson that, unfortunately, I have had to relearn many times.
The treatment-oriented patient already knows what is wrong and just wants it fixed. A DC should be able to spot this type of patient when they say things like, "Just do what you have to do, Doc!" This patient might be a guy with low back pain who has left his diesel truck running in the parking lot. He wants you to put him on his side on your treatment table, "kick-start" his knee, twist his pelvis, and hear that bone go back into place. This guy is not interested in buying a bottle of vitamins.
Don't argue with the senior patient who says, "My sacroiliac joint is out again," when you clearly find that his problem is coming from his lumbar spine. Doc Kapinsky told him 50 years ago that he has a loose sacroiliac, so arguing about where the pain is coming from is a bad idea. It will just sully the cherished memory of the patient's beloved and departed old family chiropractor. Besides, sacrum or lumbar - close enough, right?
Many years ago, in a fraternal Moose Hall somewhere in the South, a man told me the story of driving his portly friend to the chiropractor to get his back adjusted. The friend had low back spasms and could barely walk. But the DC could not "move" the guy's spine. The two men then decided they simply needed a bigger DC one who could "muscle" the bone back into place.
They drove to another chiropractic office, but that DC was apparently not big enough, either. To save gas, they started calling offices. "I just asked how tall and heavy the chiropractor was," the driver told me. Eventually, they found a woman DC, a former roller derby performer, which ended their search.
Once in my career, a patient called our office after a treatment to ask for their money back. "Dr. Hanks just didn't get that neck of mine to move this morning, so I was wondering if I could have about a third of my money back, since I am happy to pay for the mid-back and low-back adjustments." (Yes, this really happened; no, I did not return the money.) This could be the ultimate treatment-oriented patient.
Are diagnosis-oriented patients any easier to manage? No. Take the case of the man who was afraid kidney disease was the cause of his low back pain. "But Mr. Kopopkins, you told me this pain started after a fall down the stairs," I reminded him.
"Well, I heard of this fellow that had back pain and then died of kidney failure, so I think I might need an MRI or something," he replied. I made the futile observation that he was pointing directly at his sacroiliac joint, his temperature was normal, and the kidney punch test did not hurt him. It was also not reassuring to explain that I have not seen more than a half-dozen patients in all these years with kidney problems causing the back pain complaint.
I offered to refer him for blood and urine tests, but he ended up at an urologist's office, who did the lab work, a pyelogram, and then sent him to physical therapy.
It is much easier to work with a patient who has already been to other practitioners and has had all the imaginable tests done for their headaches. "I have reviewed all the lab, nerve conduction tests, and the brain MRI," I might say, "and I am confident that you suffer from a disease called neuralgia." Bingo! Diagnosis accomplished.
I have made the mistake more than once of starting to treat the patient before they were absolutely sure what was wrong and what needed to be done. This becomes painfully clear, when, after delivering a great manipulation, the patient asks, "What does that actually do, anyway?" A moment like that makes me want to excuse myself, go into the rest room, look in the mirror and slap myself.
My message of the day is simple: pay attention. When confused about what the patient wants to do, try asking, "What do you want to do, patient?" Know who you're dealing with. Otherwise, much like the late bluesman Howlin' Wolf sang, "I asked for water, but she brought me gasoline."
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