Back Pain

Back Pain
A 77-year-old woman presents with back pain.
No trauma. No radiation. No red flags.
ROS* otherwise surprisingly negative.
Her exam is unremarkable, actually pretty darn good.
FROM, negative SLR, full distal strength, sensation and DTRs.*
After the usual cautions I reassure her,
prescribe activity, no meds and the tincture of time.
She is fine with that, appreciative and pleasant.
Then she says, “Should I talk to my sister?”
They are estranged, as usual about who got Mom’s whatever.
Her sister is 86, this has been going on for a long time.
She talks. I listen.
She says, “I should call her, shouldn’t I?”
I let her answer her own question. She does.

As she leaves I say, “I hope your back feels better.”
She responds, “My back? Oh, my back’s fine.
Thanks for the talk. I’ll do it.”
How do I code this?
I find I don’t really care.

Bill Toms has been a family physician in New Hampshire and Maine. “As a family physician who has been intrigued for the last forty-eight years by the therapeutic power of listening, I still find it one of our strongest medicines.”

About the Poem

“One of the fascinating aspects of listening is that so often there is a second story lurking just under the first story, waiting for a chance to squirm out, waiting to be heard.”
*ROS: review of systems; FROM: full range of motion; SLR: straight leg raise; Full distal strength: the strength of the hand grip, wrist and ankle; DTRs: deep tendon reflexes.
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3 thoughts on “Back Pain”

  1. Pris Campbell

    Great to read another story/poem by a doctor who listens but ,while stress can certainly exacerbate medical problems, too many doctors call things emotional without exhausting all possibilities. I have no impression that you did that.

  2. artie solomon

    Fun to read poem which reminds us that the best things we can do for others and ourselves are to listen and to ask questions.

  3. it’s been a very stressful week with horrible current events, racial tension, the pandemic, very hectic workplace, but your poem made me smile and made me feel proud to be a physician. thanks for sharing this–i just loved reading it…. and i enjoyed seeing my favorite pediatric remedy in print, “tincture of time”.

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