PATIENT EDUCATION on Musculoskeletal (MSK) Issues
Patients are often misinformed about musculoskeletal (MSK) issues. They often latch onto information provided by neighbors or family members.
Sadly, a lot of MSK misinformation is provided to patients from physicians. They generally receive virtually no training in this area of medicine1. When they do a residency, they are trained in diagnosis of these disorders by staff physicians, who received no in - school training either. These staff physicians got their “expertise” as residents also.
Case in point: How often is a patient placed on their stomach in a physician’s exam room? – almost never! Even in the exam room of an orthopedic surgeon or so-called “sports medicine” specialist. Hip extension motion is never assessed. Another case in point: When a patient presents with pain in the shoulder or arm region, one should “screen” the neck for any involvement. This is called an “upper quarter screen”. In my 41 years of practice, I have only seen this done once – by a nurse practitioner. I have seen dozens of patients diagnosed with shoulder problems, that actually had a neck or upper back problem.
A physician friend of mine once commented “if Ed is to be successful with his patients, he must first debunk myths”. This is sometimes a tall order because their physician has perhaps provided them misinformation. This often leads to unnecessary testing and unnecessary prescription of risky medicine. Then when “incidentalomas” are found, more testing follows, or perhaps even invasive procedures, like biopsies.
In my practice I use anatomical models to explain my diagnosis. Most often the movement disorder, stiffness, or weakness is readily evident to the patient. They can feel it or see it. They are not looking at an x-ray or an MRI or some other picture. That image could even be from someone else, and they would not know the difference! But when they feel it on themselves, it is very real.
I do not hesitate to point out the fallacy of the information patients may have been told. They deserve the truth. And I rarely provide information that cannot be verified by research.
I have spent nearly all of my 41 years specializing in MSK and have been to many continuing education courses in this area. I haven’t memorized 5,000 medicines. I was one of the first just over 1,000 board certified orthopedic therapists in the country in 1992. So, if you want to know if you really need that surgery recommended on your knee or shoulder, and want to know what is really wrong – see me. The real beauty is that no harm will be done by unnecessary testing, interventions, or medicines.
1J Bone Joint Surg Am 1998 Oct;80(10):1421-7. (Note: This same MSK quiz was administered to 334 staff physicians, residents, and recent graduates 7 years later and 79% of them failed it)