Primary Care Low Back Pain Consultation 3: Dealing with a passive patient
Dealing with a passive patient
Dr Chris Barker, is a general practitioner with a special interest in pain and Associate Specialist in Pain Medicine, Merseyside. He is an honorary lecturer at Cardiff University and is a key opinion leader in primary care pain management. In the third of a series of three consultations, Chris encounters with a typical patient with low back pain and a passive approach to their recovery. The aim of the consultation was to give an example of a biopsychosocial approach to pain assessment but demonstrating how this can appear with lack of focus.
Things that were positive
- Adopted a patient centred style (although perhaps too much & not directive enough)
- Excluded a worrying cause for back pain – simple mechanical low back pain
- Didn’t get tempted to image his back with x-rays, but did focus upon his concerns regarding a scan
- Highlighted importance of keeping active and use of strategies to ease pain (painkillers, heat, stretches)
- Agreed a mutually acceptable way forward that was relevant to him – therefore more likely to achieve concordance
- Focused upon his workplace and importance of return to work
- Helped him address general lifestyle issues
What could have been done better
- Given a formal diagnosis – I didn’t actually tell him he had simple mechanical LBP!
- Given a timeframe for return if no improvement
- Ask about weight loss in the red flag questions!
- Stay focused and make best use of time