That......tickles!
My kids used to love it when I ticked them. My patients…. not so much. I’m not normally one for tickling my patients deliberately. But sometimes it happens after I have examined the SI joints of my patients. I move my hands upwards and gently probe into the patient’s waist. If one of the flanks is tender, a female patient will normally remark: ‘Ow, that’s a bit tender’, whereas a male patient will say ‘That’s ticklish’. The guys don’t seem to want to volunteer that there is tenderness, preferring to describe it as ‘ticklish’. I then ask them: ‘Is it ticklish on the other side too?’, as I palpate both flanks again.
Unilateral flank ‘ticklishness’ suggests that there may be some renal tenderness, in my experience. So I often find it worth reassessing this area when I assess the patient when they are supine. Nearly always, the male patient whose flank was ‘ticklish’ will concede that it is actually tender.
I feel that these patients should certainly have a urinalysis. I would be looking to find microscopic hematuria, leucocytes and nitrite. They may have a UTI that has tracked up to the kidney causing pyelonephritis. There may be renal pathology. If the renal tenderness persists then some imaging of the urinary system would be the logical next step.
The back pain that these patients consulted us about may not simply be ‘mechanical back pain’.....
I was struck by an article in the BMJ this week (1), exhorting doctors to ‘consider the patient as a whole’. It’s easy for us to forget that back pain can be caused by so many different organic pathologies.
If we examine the whole of the patient, I think that we are much more likely to consider the whole of the patient, when assessing them. I think that we are then more likely to come to an accurate diagnosis and a helpful treatment plan. Manual practitioners have much the same opportunity that GPs have to examine and consider their patients holistically (2), and we should embrace our generalism.
Sidenote:
What I'm enjoying this week: A YouTube video by one of my heroes, Danny Gregory: 'Struggling to make art? Here's what I do'. Can you apply Danny's message to your own professional work? Let me know your thoughts!
It’s a journey: Kaizen is the practice of continual improvement
I have been a chiropractor for 38yrs. I now mentor practitioners to help them become the clinicians that they want to be.
