Teaching Young Doctors

Posted On: June 27, 2016

I am Dr. David Johnson a chiropractor and physical therapist in Highland Park and Lake Bluff. I am the director of North Shore Spinal and Sports Rehabilitation. I started as a chiropractor in Lake Forest, Il in 1988. I integrated physical therapy into my practice in 1990.

As the Director of these clinics I have had the opportunity to train a number of student interns in various professions over the years. I have had medical doctors in training, chiropractic physicians, student physical therapists and student physical therapy assistants all rotate through the clinics.

Last week, I was trying to teach a young doctor how to properly diagnose a patient. He had come up with the wrong impression on a patient, assuming he had one condition when he actually appeared to have another.

It was a case of a complaint of groin pain in a 55 year old, sedentary man. He came to the conclusion that he had strained his adductor musculature. I was a bit surprised, as I would assume the complaint would be stemming more from osteoarthritis (OA) of the hip, perhaps a referral from the lower back or maybe an avascular necrosis (AVN) of the hip.

I asked if the man had been participating in athletics where he would be running and cutting or if he had slipped and fell. He said no he had only been doing his regular physical therapy exercises, none of which were challenging enough to bother his groin except for may be squats.

I said lets go examine the man. I tested the strength of his adductors and he was strong and no pain was produced. Stretching the adductors did not bother him. He did not have a SLR response. When I put him in Patrick’s FABER position on the involved side it produced slight pain but when I flexed adducted and applied overpressure through the shaft of the femur into the hip, the man had an obvious pain response.

I told the man and the young doctor that he probably has OA of the hip and possibly an AVN. We discussed that the symptoms were mild enough that with proper therapy (ROM and mobilization of the hip) that the symptoms were likely to resolve. We further discussed that if it doesn’t resolve that x-rays and perhaps an MRI of the hip would be necessary.

After the encounter the young doctor seemed a little perplexed. He felt the man had adductor involvement because he had tenderness in the musculature. I explained that the adductor musculature is in the pain referral zone of the hip. I could still see he was having a hard time with the diagnosis.

I went home and thought about non-traumatic hip pain on a time line with the congenital dislocate/dysplasia in the infant at the beginning ; Perthe’s disease, slipped capital femoral epiphysis (SCFE) and transient synovitis in children, adductor strains, hamstring strains, avulsions and stress fractures in teens and young active adults; OA, AVN and osteoporotic deficiency fractures in older adults.

I realized that by having a proper time line combined with the ability to take a good history, I was able to place the patient on the time line and more accurately come up with a working diagnosis for the patient. I went back to the young doctor and presented him with the idea of a timeline in selecting what conditions the patient is likely to have. He seemed to appreciate my feedback and perhaps by using this simple tool, he will more quickly develop into an excellent diagnostician. Time will tell.

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