June 2015

Diagnostic Tips

1. When making a diagnosis, try not to completely rely on diagnostic studies.

When a patient already has an MRI ordered by his or her family physician, it is best not to assume that the MRI scan can provide all the answers. Instead, make sure that the symptoms and physical findings are consistent with the MRI findings. Ideally, the patient should be evaluated first with a thorough history and physical examination before reviewing the MRI results. The clinical findings should agree with the diagnostic tests before choosing appropriate treatment options, especially surgical intervention. If the clinical findings do not agree with the diagnostic test results, question the diagnosis and consider other causes for the symptoms.

2. In most situations, recommend non-operative treatment options before suggesting surgery.

Alternatively, determine if another physician has tried non-operative treatment. This conversation will help increase the patient’s confidence in your skills if later surgery results in a complication. Frequently, non-operative treatment will be successful for many orthopedic problems. In certain situations, physical therapy can work wonders.

3. It is best if the patient understands why surgical intervention is needed to help improve their condition.

When the patient views the X-ray films and sees that the bone is displaced, he or she better understands the need to correct the deformity. If the patient has tried physical therapy or another form of non-operative treatment without relief of symptoms, he or she will be more comfortable with the decision to pursue surgical intervention.

Submitted by:
John E. Garber, MD
Lebanon, IN