We Went to the Specialist
My husband had an appointment with a neurologist last week to find some help with his 15-year history of migraines. I (of course) joined him for the appointment so I could better understand a plan to manage his symptoms. I should explain that even to get an appointment with the neurologist, we first had to visit his primary physician to get a referral to see the specialist, which we did last month.
My husband commented on some of his observations about the appointment from his perspective as an individual who doesn't work in health care. The appointment included an initial questioning by a medical assistant, then a nurse practitioner and finally the neurologist. He didn't understand why three people needed to be involved with questioning him (with almost identical questions) and why the recommendations between the NP and the MD differed.
The education piece of the appointment was somewhat lacking - no discussion about the function of the brain, what a migraine actually is, the research behind medications or anything else that could have helped us understand his migraines better. He didn't understand a lot of the terminology used during the appointment -- it was simply assumed that he would understand things like MRI or beta-blocker. When my husband asked me later what the difference was between the MRI and an angiogram (both were ordered), it made me realize that I may have done the same thing to my patients -- assumed they knew what an MRI or CT scan meant.
There was not much discussion on a plan to manage the migraines long term, other than drugs. A drug for circulation, a drug for nausea and a rescue drug for the worst migraines. I wondered why we weren't given any other options. Were daily prophylactic medications the only way to solve migraines? And the side effects of those medications were not discussed in much depth, perhaps because the pharmacist would review them. But at the time we wanted to know as much as we could -- that's why we went to the specialist.
It was a good experience for me to see the appointment from the patient's (my husband's) perspective. After patients see their physician (let's delay the direct access discussion), they are often referred to our services. As physical therapists, we are the specialists. I think sometimes specialists may lose sight of the "big picture" of the patient's overall medical situation and treatment because they are very focused on the details of the patient's case. We focus on what we do best, but we cannot let that be to our own fault. It's our job to remember the patient's position and consistently emphasize educating our patients not only about anatomy or their injury but also about the timeline of care, providing options for treatments and involving them in the plan.
What do you think? How do you remind yourself to care for the whole person?