By Alexander Germanis
Sir William Osler, a Canadian-born physician commonly referred to as “The Father of Modern Medicine,” is well known for having done a lot in his field. But perhaps the thing for which he is best known is something he said: “Listen to your patient; he is telling you the diagnosis.” Establishing the patient’s medical history, Sir William said, was the first step toward properly diagnosing the patient.
Dr. Ramsin Benyamin, founder of Millennium Pain Center in Bloomington, could not agree more with his distinguished predecessor. “History is the most important part of the medical encounter and has been for 150 years or more,” he says. “Unfortunately, with the way healthcare is ‘moving forward,’ this is becoming less and less practiced.” Instead, the patient is expected to fill out page after page of paperwork in regard to their medical history before they ever even see their physician.
And, as Dr. Benyamin iterated last month, when they finally see their doctor, “nobody has time to listen to the patient; nobody has time to spend with the patient. Everyone is rushing, rushing, rushing. The majority of patients don’t like it.” The doctor points out that patients and physicians are forced to do it because those are the dictates of the insurance companies. “A lot of times, healthcare providers are required to do their own documentation in the electronic chart, and therefore, they have to sit in front of the computer during the encounter with the patient.”
“If you’re looking at the computer,” Dr. Benyamin continues, “that means you’re not looking the patient in the eye.” Such a simple thing as eye contact can make a huge difference in the doctor/patient encounter. It means, the doctor says, the physician is doing more than just hearing the patient; he or she is actually listening to the patient. Proper listening will lead to not only asking more questions but to asking the patient the proper questions. It may seem obvious, Dr. Benyamin admits, but “it’s the basic things” that can make all the difference in leading to a proper diagnosis.
Another one of those basic things is the examination. Again, the examination of a patient, if used in conjunction with properly listening, will eventually lead to the real cause of the patient’s ailment, whatever it may be. Once more, Dr. Benyamin points out the simplicity but necessity of such a practice. A lack of proper examination can mean not only greater medical costs for a patient but extended suffering as well.
Dr. Benyamin shares a story of a person who came to him after their neck pain refused to diminish despite taking muscle relaxants that they were told would ameliorate their condition. The new patient disclosed they had been given an X-ray that showed mild degeneration of the spine. “The [first doctor] said maybe the patient had sprained their neck,” Dr. Benyamin recalls. “They diagnosed this with no examination! The patient was in such excruciating pain in a couple of weeks that they had called and asked if they could do an MRI to find out. The patient was telling the doctor how to find out what is wrong!”
A simple examination gave Dr. Benyamin all the information he needed to move forward. “I examined sensation, strength of the muscle, and reflex,” he says. “The patient had all three positive signs of nerve compression in their neck that could have been from a disc herniation.” A follow-up MRI confirmed the doctor’s diagnosis.
“Overall, I think one of the things we have underutilized is our expertise in identifying the precise source or sources of pain,” the doctor states. And properly identifying that source begins with listening to a patient’s history—to simply listening to the patient.
To learn about medical technology’s role in proper diagnosis, read “Simple Steps for Proper Diagnoses, Part 3” in next month’s issue of Healthy Cells.
Millennium Pain Center, located at 1015 S. Mercer Ave. in Bloomington, provides the most advanced and comprehensive pain management for a wide variety of conditions. Drs. Benyamin and Vallejo have been selected among 70 of the Best Pain Physicians in America. For more information or to schedule an appointment, you may contact them at 309-662-4321 or online at www.millenniumpaincenter.com.