His file was pulled for a chart review and was used as an example of my poor performance. The doctor had sent him to the office for radiculopathy, but (by not performing repeated motion testing) I had not “ruled out” the back as the “source” of his pain. Instead, I had “just treated his left leg”. I should have repeatedly flexed him, extended him and laterally flexed him. Reading my evaluation, she was frustrated, “You evaulated him, and I still don’t know where his pain is coming from!”
She had already expressed her frustration with me earlier in the conversation. She had told me, ” We know you are smart, stop trying to convince everyone that you are by talking about the brain,” so I knew that a truthful response would be less than productive under these circumstances. In my mind, I imagined the expression on her face when I asked her, “Well, all pain comes from the brain, doesn’t it?”
Instead, I simply replied, “I understand,” because I did. She has practiced (successfully) for over twenty-five years. She knows that the outer third of a disc is an innervated pain generator and that her patients get better in the pool because of reduced compressive forces from buoyancy. Her knowledge has been validated by the improvements of countless patients over all those many years. In this instance, I understand where she is coming from, even if I silently disagree.