The Art of Asking: Show Me Where it Hurts

Norman Grant was a new patient. He had chronic back pain, not helped by surgery or a dozen injections after that. It all started with an industrial accident in 2001. He had settled his case and was on chronic OxyContin, which far from kept him functional. But as of January 1 his insurance was no longer covering that drug. He only had two weeks left of it.

He told me he hurt when he rolled over in bed, when he walked or if he sat or stood still too long. He didn’t have sciatica. His legs had normal strength and sensation. He could bend his back forward or back without too much pain.

I was puzzled.

“Show me exactly where your back hurts”, I asked him. He pointed low, to the right. I banged with my fist on his spine and palpated the muscles along his lumbar spine. No pain. Then I pressed over his left sacroiliac joint. No pain. But the right one was exquisitely tender.

I asked him to lie down on my exam table. I tested the range of motion in his hips and it was pretty normal. Then I checked for pain in his left S-I joint by flexing his hip and knee and pushing his left leg to the side and toward the exam table.

“It hurts on my right side”, he said.

I repeated the procedure on his right side.

“Ouch, I feel a click when you do that”, he exclaimed.

“Did anybody X-ray your S-I joints or your pelvis or talk about that area?” I asked.

“No, but I kept telling them it wasn’t my spine that hurt, it was down there.”

“We need some X-rays of that area, and there may be things we can do for you besides giving you more or stronger pain pills”, I explained.

He grinned and thanked me.

“I kept telling them I hurt down there, but they wouldn’t listen or check it out the way you did.”

“Well, we’ll see, maybe we’re on to something”, I said. I wondered to myself, could it really be that he had a disc herniation that really wasn’t causing any of his symptoms and his S-I joint problem had been overlooked for all these years?

5 Responses to “The Art of Asking: Show Me Where it Hurts”

  1. 1 Laurie Thomas MD January 22, 2021 at 9:32 am

    I wish there were more research on NONspinal back pain

  2. 2 meyati January 22, 2021 at 3:33 pm

    The answer is YES– Listening is a lost art.

    I wish that doctors and nurses had to take a mediation course every 3 years. I say–mediation– instead of –Communication– Communication is too talky and doesn’t make listening that personal-the responsibility is not on you–and you need to learn a 1,001 catch phrases.

    I found mediation usually puts the participants into practice groups, which includes paraphrasing and other methods to show that you are actually listening to the problem.

    • 3 Laurie Thomas MD January 22, 2021 at 10:51 pm

      The problem is not that doctors don’t know how to listen. The problem is that doctors don’t have time to listen. We are so squeezed by health insurance dictates that we have to
      1–Spend less time on patient care to do all the red tape insurance companies demand, and
      2–See more patients per day to stay in business when insurance cuts what they pay us

  3. 4 ejmiron January 31, 2021 at 9:08 am

    Please give us follow up on this patient

  4. 5 ejmiron January 31, 2021 at 9:08 am

    Please give us followup on this patient

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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