Doctors must remember to treat patients, not test results

I’m going to share a recent experience with a patient that reinforces what we were taught throughout chiropractic college, “treat the patient, not their test results”. This is especially true when talking about diagnostic testing such as MRIs, Xrays, nerve tests, etc. More often than not, “findings” on these tests have little to do with the reason a person is having pain or discomfort.

First, I want to point out that this is not a new concept. There have been a number of studies done that has concluded that MRI and xray findings do not correlate very well to what’s actually causing a person’s pain. In fact, you can take 100 people over the age of 40 and perform an MRI of the low back. Odds are that about 40% of these people will have abnormal findings. Yet, out of these 40 people, only a small percentage will have low back pain. As for the rest of the people who did not have any findings, some of them will have low back pain.

So, whenever I talk to someone and they tell me they have this disc bulge or that degenerative disc issue or arthritis of the spine or whatever, I have to explain that it’s important to know that information, but we can’t solely rely on it to figure out how to treat them.

The bottom line is that test results should make up only part of the overall diagnostic picture. If I had to put a number on it, I would say it only makes up 10-20% in most cases. Same goes for things like thyroid problems. The TSH test result only paints one part of the picture. Symptoms, how a person feels, physical exam, etc. are just as important. I’m sure there are people reading this with a thyroid issue on meds with “normal” TSH levels that still feel like they are hypothyroid. BUT, that’s another post for another day.

So, back to my patient. She is a 30-ish year old female who had been suffering with neck, right shoulder, right arm, and hand pain, numbness, and tingling. It was quite bad, not allowing her to get good quality sleep, participate in her daily activities, and even got so bad she had to go out on disability from work. This was a major life changing issue and she needed help.

She started out at the family doctor. I think they tried some pain meds and perhaps a muscle relaxer. That wasn’t working, so they referred the patient to a hand specialist. In the mean time, the patient decided to come to see me. After talking to her for a few minutes and examining her, I felt strongly that at least some of her pain was coming from her neck. Major clue was when she looked left, pain went away. When she looked right, it screamed down her arm. I spoke with the family doctor and said even though I thought it was a neck issue, that the hand specialist consult wouldn’t hurt. So, I began working on her neck and right arm to see if what we did at my office could help her issue, while waiting to see what her other doctors figured out.

The hand specialist saw her and sent her for several tests including a needle nerve test, bone scan, and xray of the right hand and arm region. She also had an MRI of her neck done at some point along the way too. All were relatively normal. Minor findings, but none that the hand specialist thought would be causing her pain. In fact, he thought that because these tests were “normal”, the patient shouldn’t be having pain. He suggested that it was because she was depressed and wanted her to see a psychiatrist. Sorry, doc, major FAIL on this one.

So, the patient is very upset at this point. She’s been suffering for months and now she’s told nothing is physically wrong with her. She knew that wasn’t the case, but didn’t know what to do. Her family doctor decided to send her to a totally different orthopedic group for another opinion. Long story short, they also sent her to the hand specialist in their group where she received two injections in her hand and was told to wear a hard hand/wrist brace as much as possible and to see them in a week. She saw me in the mean time and explained what they had come up with. At least they didn’t try to say she was depressed (although dealing with all of these doctors’ visits was getting her there). Actually, at this point, I thought perhaps I was the crazy one. How could two of the top orthopedic groups in this area of the state both miss the boat on this one? I said that when she goes in for her follow-up, to specifically point out that when she moves her neck, the pain changes. She did, they didn’t care, and they gave her another injection or two and told her to come back in a month. Another FAIL unfortunately.

So at this point, I’m pretty sure that I’m not the crazy one. I send her to the spine specialist I use on a regular basis for consults. I know he is very good, very thorough, and will not do anything unless it’s absolutely necessary. His name is Dr. Abraham of Reading Neck and Spine. He takes one look at her MRI (he actually looked at the image and not the report, which didn’t do it justice) and asked her a few questions and could not believe the other docs missed the boat so bad. Basically, she had a few issues that caused compression of the nerves as they exit the spinal column and she needs to have surgery to decompress stabilize. I never saw a patient so happy to report that she has to have neck surgery. She was just happy to finally get an answer to her problem with the hope that she will soon find relief.

This is just one of the many cases I see where doctors rely too much on diagnostic testing and not enough on speaking with the patient, performing a proper physical exam, and touching the patient to find out where they are having issues. I’m nowhere near perfect and I’m not suggesting that, but I did want to share this case with other doctors out there and with people who are having issues that might not be getting anywhere because of a situation like this one.

Please do not hesitate to contact me with any questions you may have regarding a similar situation. I may even send this blog entry to all of the other doctors that saw this patient for this problem, and they are invited to contact me as well : )

One thought on “Doctors must remember to treat patients, not test results

  1. Dr T,

    Thank you for taking the time to listen to your patient and share your concerns. You make a very valid and scary point. I have seen with my own family where needless expensive tests were performed in the name of “good medicine”. I choose to listen to my body first and foremost.

    A fan,

    Lee Yeager

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