Selling fear

Communication is an often overlooked, but very important aspect of either doctor-patient or therapist-patient interaction. When patients refer friends and family to certain practitioners, it is because they obviously believe that practitioner is skilled in their field, but also they must have had some level of positive interaction as well. People don’t tend to refer their friends to jerks. Having a good rapport with patients is critical for doctors in order to establish trust so that patients are more likely to follow your recommendations. And as an obvious benefit for the doctor (especially one in private practice), those patients will return if and when future problems arise.

Over the last couple of weeks there have been a couple of very interesting blog posts written about the use of certain language used by doctors or therapists can that negatively influence patient perceptions and expectations (one of them written by a chiropractor is here). As an example I often review x-ray and CT scan reports with my patients in order to give a clear understanding of what they mean. Patients often are alarmed by the language contained in these reports because out of necessity in the radiology field, most reports contain wording that leads a patient to believe their ailment is more serious than it actually is. Phrases such as “degenerative changes” or “disk space narrowing” or “reversal of the cervical curve” give the impression to the patient that something is really wrong. And while this phrasing is technically appropriate and is required for clarity in report interpretation, how it is relayed to the patient is problematic. Patients hear these words and understandably get concerned. The problem is that most of the time these are changes that have been happening for years and are likely not related to the patient’s current complaints and are mostly normal for their age bracket. Most patients arrive in my office with acute musculoskeletal pain, which affects their function, yet doctors are quick to attribute their symptoms to structural changes (through imaging), which were present long before the new complaint.

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In most instances (and especially with younger patients) imaging in the form of x-rays or a CT scan is not required and should NOT be used for dealing with musculoskeletal complaints. They should be used if Red Flags appear as part of the physical and orthopaedic exam that should be performed on a first visit. I have written previously on the use of both X-Rays and MRI in previous articles, which can be found here and here.

The job of both therapists and doctors in a clinical setting is to focus on enabling our patients; not to create fear and dependence. Patients have to be encouraged to move and to keep their levels of function and mobility high. I always try to encourage my patients to think about activities that they can be doing rather than what they shouldn’t. It is well know that regular activity is a much better treatment approach for aches and pains than rest and inactivity.

Sadly, some practitioners use x-rays to create that exact fear to set the stage for what is likely to be a long treatment regimen based on their ability to sell whatever treatment they use to “cure” what is likely not a major problem to begin with.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.