Category: Individual Treatment

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Diagnosing pain.

Did you know that there is a diagnosis code for virtually every part of your body plus the word “pain.”

Low back pain M54.5
Pain in the Thoracic Spine M54.6
Pain in the left foot M76.672
Chronic Bladder Pain R39.82

There are also diagnosis codes for significantly more detailed problems. This is often the reason for the “pain” diagnosis. I can diagnose right facet joint arthritis, or cervical degeneration that causes radiculopathy. There is value in both forms of diagnosis.

When you, the patient, comes in, you usually tell me about how you’re feeling. This discussion revolves, most commonly, around your pain. I will dig around and ask some questions and let you tell me your story. At this point, I can easily diagnose you with your specific pain diagnosis. You come in with neck pain, and I can diagnose neck pain in about 3 minutes of meeting you.

In the next step, I get to dig around and find out if there is an even more specific diagnosis that explains the “pain” diagnosis. This is the part where I rule out the really serious diagnoses, like a broken bone or a torn ligament. It is the part that takes a lot longer, occasionally more than one visit sort of longer. This is the part where we will usually throw out the fancy words. “Hip Impingement” or “Arthritis.” (And occasionally these fancy words come with an even fancier test.)

Now here is the really tricky part. Getting rid of pain can be really easy. (Tylenol, Gabapentin, Codeine) But getting rid of the fancier word part, the actual cause… now that is a lot harder. Just like diagnosing it requires a deeper understanding by your doctor to name it, it also requires a deeper understanding by you, for you to heal it.

Notice I said “You” to heal it. I can help you get rid of the pain and understand what needs to be done to heal, but the longer term changes, that is going to take more than just coming to see me a few times and taking tylenol for a couple weeks. There is a good chance you’ll need to support your body with movement, nutrition, rest and time.

This is a process. I hope to teach you everything you need to learn to heal, but it takes time. It takes time for us to peel away the layers that got you into pain in the first place and it takes time to explain each new healing step as we reach it. It will take time for you to make the changes you need to stay out of pain.

As Always,
Keep Moving.

Dr Cate

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“We do that on everyone” – The Insurance Debate

The great insurance debate.

So I had a small medical concern that I wanted to get checked out. I went to see my favorite Nurse Practitioner (Rachel VanBree at The Women’s Birth and Wellness Center) and we had a chat. We started with the usual discussion of my symptoms and she didn’t rush me. I went in knowing what I wanted to bring up, the timeline of things, the things I had ruled out and the things I knew I wanted to rule out. We set up a plan. She wanted me to get a test done, she told me the best time to get it done, what the next steps would be if we didn’t see anything on this test and what we would do then.

A few weeks later I had my reminder call and my pretest instructions from the office. I also had the discussion with my awesome NP rolling through my mind. I had looked up the approximate cost of the test because I knew my insurance wouldn’t cover a penny of it until my deductible was met. I went to the front desk, checked in, and inquired if they knew close to the exact cost of the test. She rattled off the cost that it would be if it were cash, but that could be very different if it were billed through the insurance. But after she stated the price, 2 things happened. First, my mouth dropped because it was 3 times as much as it suggested online and second, I knew something was incorrect.

I asked her if the cost she quoted were the tests that were recommended on the referral form. The first test was what I was expecting, the second I was not. The front desk said that the referral said, “If it looks needed” in reference to the second test, which made sense to me. I also realized the front desk there couldn’t make any changes, so I figured I’d mention it to the tech.

I was taken to the next waiting room, where they promptly came to get me and I was whisked into the test room. I immediately asked about the second test to which the tech said, “We do that on everyone.” I asked if we could base the decision off the first test and she said again, “We do it on everyone unless you refuse to have it done…”

So I refused, the tech said, “No problem!” and we went about doing the first test…

So why do I feel compelled to share this story with you? So many reasons!!

First – If you hadn’t had the in depth conversation with your primary, you might not be 100% certain of the reasons for your test. I felt prepared to make the decision about MY healthcare and I felt  comfortable saying no.

Second – It might be completely covered by insurance and you wouldn’t blink an eye.

Third – If the second test is better at seeing what we were looking for, why wouldn’t they skip the first test, and go right to the second test!?

Fourth – Because it brings me back to this constant internal struggle that I have with my own patient centered business plan. To take insurance, or to not take insurance. As most of you know, I’m currently a “cash only” practice. Which means we do not file insurance for anyone (Except medicare patients.) About once per week I think, maybe I should take insurance and I always come back to the same reasons: I think a lot of patients would benefit from being able to use their insurance and it might be a good idea from a business perspective.

But in this patient transaction I saw exactly what scares me about insurance from a business perspective. “We do it on everyone.” as well as how easy it would be to simply go with the flow and allow others to make the health care decisions for you.

So for now – we shall continue to be a cash only practice until my patients urge me to do otherwise…

In the meantime, do you have any similar stories? We’d love to hear them!

As Always – Keep moving,

Dr Cate