10 Things to Expect At An Appointment with a Bone Doctor
Preparing For Your Appointment
When you make an appointment with a "bone doctor" or orthopedic physician, there are several important steps that must be taken to ensure that the visit is both productive and effective. Bone doctors have a very specific list of things that they need to have at the initial visit to ensure that they can provide the most effective care for their patients. The absence of any 1 of these important items can lead to a delay in the doctor's ability to offer you medical treatments at the first visit. In cases where important information is not readily available to the doctor at the fist visit, they will often ask to see you for a follow up visit in 2-6 weeks so that all the information can be gathered before treatments are considered. This tutorial will provide you with the necessary tools to make sure that you have everything that you need when you go to that first visit.
5 Things to Bring to the Initial Visit
When you present for your initial visit, there are several things that the doctor will be looking for so that he/she can provide the best and most efficient medical care. These items are things that you can easily obtain from information that you have at your house or information that you can get from your primary care physician or other doctors that you have recently seen. The information that you gather should be typed, if possible, and should be easy to read.
1. The doctor will need to see a comprehensive list of medications that you are currently taking. This list can be hand written or printed out by your primary care doctor (PCP). If you are taking several medications, it may be helpful to ask your PCP to provide you with a list so that you don't miss anything important. The list should include the name of the medication, the physician who is prescribing it, what condition it is prescribed for, and the dose. For example, if you are being prescribed Naproxen, which is an anti-inflammatory medication, by your PCP, the list should include the following:
-Naproxen 500mg taken twice per day for lower back pain, prescribed by Dr. Doe (your PCP's name)
You can use this same template to list all of your other medications, as well. The list should ideally be on a separate piece of paper so that you can just hand it to the nurse or medical assistant who takes your history. You should also make sure that you have your own copy of the medication list for future reference before you hand it over to the doctor.
2. The doctor will need to see your past medical history, including any diagnoses for which you are currently treating, surgeries that you have had in the past, and allergies to medications. In most cases, having a list of your relevant medical conditions and diagnoses is important when you see any kind of specialist doctor. Having this information readily available and easy to read will save time for you and for the evaluating doctor, as history taking during the initial visit can be somewhat time consuming. Additionally, it is possible that you may forget an important condition or diagnosis when you are at the visit. Having a list will help to prevent this.
3. The doctor will need to review any prior diagnostic studies that have been completed for the diagnosis. In the case of lower back pain, any prior x-rays of the lower back, MRIs, CT scans, or electrodiagnostic tests will be vitally important to ensure that you have prompt access to necessary medical treatment. In most cases, an x-ray is the initial study that is performed for a patient who presents with lower back pain and, as such, this has usually already been done before you make a visit with an orthopedic doctor. In some cases, an MRI or CT scan was also obtained early in care and should be brought to that initial orthopedic visit with you. Orthopedic physicians usually prefer to review the actual x-ray films or MRI/CT films, so if you can get a copy of the films or a CD with the films on it, you will be saving your doctor a lot of time trying to locate these on his/her own.
4. The doctor will need to review any prior treatments that have already been tried for the diagnosis. For lower back pain, you may have already been treated with several different classes of medications, physical therapy, chiropractic therapy, acupuncture, injections, or other treatments before you see the orthopedic physician. Having a comprehensive list of these treatments, including the length of the treatment, the date of completion, and your response to the treatment is also vitally important to ensure that you have prompt access to necessary medical treatment.
5. The doctor will also need to look at and inspect any assistive devices that you have used or are using, such as canes, walkers, braces, etc. If you are not using any type of assistive device or brace, then this should be conveyed at your visit.
As long as you have all 5 of the above mentioned items at your initial visit, you should have access to necessary medical treatments relatively early on after the visit. The doctor will still need to verify coverage for treatments with your insurance and in some cases request authorization for treatments, which may take some time. However, patients who have all of these 5 items at their initial visit are very likely to have access to treatment before patients who do not have all of these items, as it takes some time for the orthopedic doctor to compile all of this information without your direct help.
Summary of Items Necessary at First Visit
1. Medication List
2. Medical History/Current Diagnosed Medical Conditions
3. Diagnostic Tests, Imaging
4. Prior Treatments and Response
5. Assistive Devices/Braces
5 Things to Expect At the Visit
After you have compiled all 5 of the above noted things and you present for your actual visit, there are several things that are common to every appointment at an orthopedic physician's office. Any time that you visit a new doctor, it can be somewhat overwhelming to process all of the information that is presented and all of the questions that are being asked. Knowing these 5 things will help ease some of the anxiety associated with that first visit.
1. The doctor or doctor's assistant will ask you a lot of questions about your condition. Remember, this is normal. In orthopedic medicine, a lot of times, symptoms are unique and subjective in nature. It is necessary for the physician to know how your pain feels, where it is located, when it is worse, when it is better, what makes it worse, whether it radiates to other body parts, and whether it was caused by one trauma or specific activity. All of these questions help the doctor to formulate a treatment plan that is aimed at treating your specific problem. For patients with lower back pain, there are multiple different causes, all of which have unique symptoms, aggravating factors, alleviating factors, and characteristics. It is important to remember that the doctor is not questioning your validity, he/she is simply trying to understand what could be causing your pain.
2. The doctor will do a comprehensive physical examination. For someone with lower back pain, it is necessary to not only examine the lower back, but to also examine the legs, the mid-back, the abdomen, the pelvis, the neck, the feet, and even the arms. In orthopedic medicine, comparisons can be made to other non-painful body parts or non-injured legs. For a person with just right leg pain that radiates from the lower back, the doctor will want to compare the right leg to the non-painful left leg to see if there are any differences in muscle strength, sensation, muscle tone, temperature, etc. The exam will also include specific orthopedic tests wherein the doctor will ask you to perform a task or to assume a position to determine if it is painful or to determine if there are limitations in motion.
3. The doctor may need to obtain an additional x-ray in the office. Although you may show up to the visit with your x-ray films in hand, don't be alarmed if your doctor tells you that he/she needs to do another imaging study. X-rays can be done with multiple different visits, including anterior to posterior view, lateral view, laying down, standing up, flexing, extending, etc. If the x-rays that you have already had do not include the views that are necessary to best evaluate your condition, then additional x-rays will be completed and are usually done on site/in the office.
4. The doctor will inform you of his/her diagnostic impressions. Once the examination is complete, the doctor will inform you of his/her opinions on what might be causing your pain. This may include a list of several different things that it might be or it may be one definitive cause. Either way, this will give you an opportunity to ask questions about the condition/diagnosis.
5. The doctor will formulate a treatment plan and discuss alternatives with you. Orthopedic medicine typically includes a step-wise approach to treatment. The general recommendation is that you start with the most conservative treatments and if they don't work, then you consider more aggressive treatments to include injections and possible surgery. If you have not had therapy, this will usually be recommended first along with medications. If therapy has not helped, the next step is usually some type of injection. For the lower back, injections would include an epidural steroid injection into the spine, a facet injection to the joints around the spine, a sacroiliac injection to the joints of the pelvis, or trigger point injections to the muscles around the spine. Each of these injections have very specific indications for use. If injections do not help, then a surgical recommendation may be made. The doctor will you inform you of the type of surgery they recommend, the alternative types of surgery that may also help, as well as any risks of surgery and potential complications. It is important that you ask as many questions as you need to so that you can make an informed decision on your treatment.
Although initial appointments with orthopedic doctors are usually quite time consuming, each of these steps is essential in providing you with appropriate treatment options. You can expect somewhat shorter follow up visits after the initial visit
Summary of 5 Things to Expect at First Visit
1. Expect a lot of Questions!
2. Expect a Thorough Exam of Multiple Body Parts!
3. Expect a Possible Repeat In-Office X-ray.
4. Expect a Discussion about the Diagnosis.
5. Expect a Discussion about Treatment Options.
Are you prepared for your upcoming doctor visit?
© 2018 Kortney Tholen