Covering your back

A patient was recently referred to me for treatment of chronic LBP which he sustained after an accident 10 years ago. Since his accident was workplace related, he got workers comp and lots of intensive physio and hydro after his operations. However his worker's comp ran out a long time ago and he found he was able to manage his pain by going to the gym and doing hydro. In spite of his pain, he works a job which involves periods of standing and enjoys gardening.

This patient reported much higher levels of pain and neuro symptoms which had been increasing over the past 18 months. His neurosurgeon suggested he have a spinal fusion +/- laminectomy of his Lx spine due to central canal narrowing and disc degeneration, and my pt has to make a decision by November. My patient asked me if physio or surgery would be the better option and he would rather not have surgery because the surgeon gave him a 50% chance of improving. 

He also told me he didn't want to be a burden on the health system and having lots of physio would mean that he didn't need to take up a bed in a hospital. He said that he knew that it would take more than 8 sessions (the maximum the outpatient dept offers) to get better. I wasn't comfortable in telling him what to decide but advised him that his CT's showed degeneration which wasn't going to get better over time and if he continued to do heavy gardening and not rest while he was standing up to work he probably wouldn't see a decrease in symptoms. I also told him that outpatients couldn't see him for anymore than 8 sessions and he would get physio after an operation if he decided to have one. I advised him to go and seek the opinion of his neurosurgeon and ask specific questions about why it was in his best interests to have the operation and then he could make an informed decision rather than asking someone (me) who doesn't have the knowledge to give him accurate advice. 

From this experience, I have realised the  important for pts to be informed and educated about their condition by the right people so they can make decisions themselves and we can decrease the chance of legal repercussions back on us.