Healthy Life: Diagnosis & Treatment 2 (866)

Healthy Life: Diagnosis & Treatment (2)

蘇鎮邦 (Christopher So)：
舒整物理治療師 (Manipulative Physiotherapist) 人類工程師 (Ergonomist)

Many patients have the attitude of trying out different physiotherapists to see who suits their expectations. This is not wrong, because some approaches may be more suitable for certain conditions. However, a patient needs to give each physiotherapist enough time to sort out which approach suits his / her condition.

One patient had applied for the Medicare Enhanced Primary Care Program (EPCP ) for 5 free treatments per year. He had tried out different therapists including masseurs, osteopaths and chiropractors. This time he came to me. At the start, he told me he had neck pain then he added that he had back pain. Immediately, I explained to him that there was a time limit. Also, we bulk billed EPCP which had a lower rate. We could spend the same time as a patient paying normal rate and no more. I suggested to him that I would spend 2 treatments on his neck condition and 2 on his back. Then, the last one on whichever he felt was necessary. However, the initial consultation is 40 minutes. I could examine both conditions but treat his neck the first time.

I examined him very carefully. I realized this type of patient is very demanding. His neck problem had existed for 7 to 8 years with referred pain to his right arm. His sleep was beingaffected 3-4 nights a week. It indicates the severity of his condition when it can affect his sleep. When I asked about his back condition, I learnt that it happened 30 years ago. He lifted a very heavy object and twisted his spine resulting in right sciatica. He had physiotherapy treatments for more than two years and recovery was about 80% only. This time the back and leg pain flared up about 3 months ago. Other details are too much to include in this article.

When I observed his neck and back movements, they were moderately to severely restricted. On account of arm and leg numbness, reflexes were examined and found to be positive on the affected side. Most likely, the nerves were pinged by bulging discs. On palpation, the corresponding spinal levels were painful and stiff.

After examination, I used a lot of time to explain to him the severity of his condition. It is absolutely important for him to manage his condition rather than relying on therapy for long term management. I emphasized correct posture to prevent further degeneration of the spine. In total, I used 50 minutes which was 10 minutes more than normal.

In the end, I treated his neck condition very carefully and gently. I warned him that after the first treatment, there might be some soreness but this usually lasted for only few hours. He should be better the next day. I taught him some neck and back exercises.

Sadly for his sake, he said he was not happy with the treatment. He said he had undergone treatments over the last 30 years and saw many therapists. He commented that my treatment was too simple. He said some twisting usually helped him in the past. He felt my treatment was useless. He wanted to take the referral form back and go to other therapists. I mentioned that I had spent more time than I usually spent with other patients. I did not say more and gave him back the referral form.

If the patient knows more than the physiotherapist and what type of treatment is more effective, then he himself should be the therapist. I do not mean that we should not listen to patients and their previous responses to treatments. However, we have to decide which treatment is most appropriate. If not, we are only technicians not therapists. Such patients who doubt their therapists will never find one who can cure them, but only those who please them. I would not sacrifice my reputation just for 50 or 60 dollars. I am on the verge of retirement. I have met many patients in the past. This one did not surprise me.

Moreover, as a Christian physiotherapist, diagnosing and treating the problems of a patient is only one aspect. I will attempt to understand their psychological side. Some patients have come across a lot of therapists. They think they know all about physiotherapy treatments. They tend to compare different physiotherapists and failed to understand the normal course of diagnosis and treatment. As the Chinese saying states, doctors treat their patients as their own children. Whatever I do, as long as it is acceptable to my conscience and others, there is nothing more important than this.