Medical Specialist Appointment and You

By Amy Price PhD
You have been sent to a specialist…what next? First of all sort out what you expect to happen as a result of this visit. What are your goals? Make sure they are realistic. If this was easy your primary care doctor could probably fix it.

Before your visit explain what records you have and ask which of these they would like you to copy and pre-send. Usually you can get copies of MRIs or other diagnostic tests on CD. They are easier to carry with you or send than bulky films. If you choose to send your diagnostic results and films call and confirm they arrived. Get a cost for a cash price unless you have medical insurance which will cover your visit so that you will know your costs and if you can absorb them.

If you are making a distance appointment insist on a phone consultation so you will know if your expectations are viable. If the staff you speak with don’t have information about a certain area make arrangements to call back when it is available. This way all the preliminary material is out of the way and your appt can focus on what is most important. Explain you are travelling from out of town and are in pain and request the best time of day to be seen promptly. Emergencies or office back ups can still happen but this step minimizes the possibility.

Write down what you consider to be the most important things you want covered in your visit. The reason you may want to do this is because chronic pain and injury can cause us to be sidetracked by emotion. You may get a compassionate response but it may eat away at the time available.

This is the place to get your MRI and other diagnostic tests explained. The doctor that ordered the test is the one who needs to explain it. Get an advance copy of the report and ask about what you don’t understand. We get emails every day from people who want us to translate the MRI or other diagnostics. We cannot do this because the MRI is only part of the equipment needed for a diagnosis. It is your job to make sure you understand your diagnosis before you leave the doctor’s office.

It is helpful to plan a nice dinner out or a treat for yourself for afterwards and if you can, take someone with you who will remember what the Doctor says. The reason for this is it will be difficult for you to reconcile yourself to a 40 minute appt when the injury has taken over your life 24/7. Even though your appointment time may be quite generous, logic and rational thought cannot always be counted on, when you just want it fixed.

Now relax and trust the specialist you have chosen!

Predictive medicine can change our tomorrows today. Regenerative medicine can replace artificial body parts with lab grown technologies while genetic breakthroughs can save families from generations of genetic disability. It is possible that new knowledge of human genetics and cell biology is likely to transform medical practice. Three likely scenarios could evolve:

•Genetics will lead to the classification of diseases on the basis of the underlying genetics or biochemistry, rather than by symptoms alone leading to preventive rather than crisis orientated treatments.
•Genetic information will identify people who are likely to respond to drugs, or to be harmed by them (pharmacogenetics). This is already possible with certain psychotropic drugs on an experimental level but has not trickled down into mainstream medicine.
•Genetic variation will be a new ‘susceptibility factor’, permitting monitoring and early treatment or, perhaps prevention, of an increasing proportion of common, multifactorial diseases, such as coronary heart disease, hypertension, stroke, cancer, diabetes and Alzheimer’s disease. Even stress management can be amplified with knowledge of individual genotypes

It is the genetic variation susceptibility factor which is considered to be the change maker for the advent of predictive medicine. This could lead to regenerative medicine on a cellular (somatic) level or even in vitro gene manipulation (germ line therapy) which could prevent intergenerational transfer of genetic disabilities.
Predictive medicine, when it comes, will be based on a much wider use of genetic testing, at present the gap between what the healthcare system is geared up and trained to deliver and what is scientifically viable is huge. For example there are treatments approved for traumatic brain injury that are effective but most be given within a couple of hours of trauma. This can’t happen now because emergency room personnel are not adequately trained or equipped to diagnose MTBI… As with any new technology applied to health in the context of a complex delivery system, implementation is not going to be simple.

First, of course, there needs to be demand from medical personnel and the general public. Typically wide spread change will only take place after the following criteria are established:

•Demonstration of clinical effectiveness and patient safety – through statistically valid clinical trials
•Cost-effective for general use – through economic analysis of trials and other data;
•Standardization of technology, and quality control – generally through outside regulation of suppliers and laboratories;
•Allocation of resources;
•Recruitment and education and training (or retraining) for health workers – including specialists, MDs, nurses, counselors and technicians. For instance a surgeon who makes a good living performing spinal fusions and cervical repairs will need significant convincing, retraining and motivation to become an early adopter of treatment that makes the previous way of doing business obsolete.

Predictive, regenerative medicine may be the wave of the future. History teaches us that the way to greatness is to find a way to serve many. My dream is to witness a generation of scientists and medical professionals join in unity with a foundation of integrity to build a tomorrow for the patients and public who have make their careers possible.

References:

Materials adapted from Open University Course Materials (accessed july,2009)

MRI Scanner image coutesy FSU.EDU, 2009

MRIs have gone through multiple changes and improvements in the last few years. A first class radiologist is the best way to get an accurate diagnosis but great equipment helps too. People ask us  how can I know that my radiologist does quality work? The best way is to ask who others consider the best. Ask at your Doctors, at physio and at the hospital. Soon you will find some names come up over and over again. It is important to find out what kind of MRIs they are best at reading. Some specialize in the brain, tumors, or spines. all radiologists are not considered equal so choose with care! For an explanation of how they work and the history of MRI click here

Before you agree to an MRI it is good to find out who will be explaining the results and the technical terms in your report to you. We get multiple requests to explain results of MRIs. We can not help with this as an MRI is only a part of the picture, diagnostics are made in conjunction with detailed physical examinations and patient/physician consultation.

MRI machines work with magnets and the strength is measured by Tesla. The Tesla strength can vary anywhere from .046 to 8 Tesla. Before you book an MRI ask what the strength is of the machine they will use for your scan. The strongest Tesla in common use outside of research settings is a 3 Tesla. The stronger the Tesla the clearer the image. Large herniations can be seen with an .02 Tesla. Using a 3 Tesla even ligament damage is quite visible. Click here It used to be thought that 7-8 Teslas would not be safe for patients because of the radio frequency but these fears proved groundless click here and this Tesla strength is used for revealing vascular structure and for detailed brain scans.

MRIs can be with or without contrast. A contrast MRI makes it easier for the diagnostician to see scar tissue that may have formed because of the injury. The contrast is a small amount of water soluble dye that is injected at the time of your MRI. MRIs can be static or functional (fMRI) fMRIs measure function. Oxford University has an interesting and informative site detailing how fMRI works and the strengths and perceived weakness of this approach click here

Technology combining MEG (measures brain’s electrical activity) and fMRI are bringing hope for treatment in previously uncharted territory Click here Software can convert images into 3D For more info and to see axonal motion in 3D click here The software technology in detail click here
Stand Up MRIs are thought to show structural patterns more clearly and can signpost where a client is feeling pressure. Some ligament damage can also be shown more accurately with the stand up MRI. Click Here Research done on this method click here A new and promising technology is on the horizon to reduce MRI costs and also create a machine that can be used for those with metal implants or even to assist in surgery! Click here

Thought For Today “” “Nobody can go back and start a new beginning, but anyone can start today and make a new ending.”- Maria Robinson quote