As a Chiropractor serving Gwynedd, Conwy and Anglesey I see many patients from local towns such as Colwyn Bay, Llandudno, Conwy, Penmaenmawr, Llanfairfechan, Bangor, Caernarfon and Abergele with neck pain or back pain at The North Wales Spine Clinic.  The first and one of the most important steps with new patients is a thorough history.

One particular question that brings about an amazing variation of responses refers to previous treatment from other clinicians.  I will always ask ‘what was the diagnosis?’  Responses range from blank stares, the rather indistinct ‘it was something to do with a twisted pelvis’, the old classic and very vague ‘I’ve got a vertebrae out of place’, to ‘they didn’t give me one.’

The next question, begged by the previous is ‘why haven’t you gone back to the previous clinician?  The response is usually – ‘it wasn’t working.’

(Medical diagnosis refers both to the process of attempting to determine the identity of a possible disease or disorder and to the opinion reached by this process.)

As a Registered Chiropractor in North Wales I believe it is imperative to help patients understand their problem.  It enables patients to take charge of their issue, to amend and change their own environments either at home, whilst exercising or at work and therefore stop any further possible damage.  It’s vital for a clinician, be they a Chiropractor, Osteopath or Physiotherapist to arrive at some form of diagnosis, after all we can’t treat what we don’t know.  If we don’t know what were treating how can we know what is causing the damage and how long it will take to get better? – The prognosis.

Chiropractic Clinical Clarity

(Prognosis – (literally fore-knowing, foreseeing) is a medical term to describe the likely outcome of an illness.)

So a specific diagnosis is vital and should shape the type of care you receive and also aid formulation of the prognosis.  So why don’t we know our diagnosis and how do real experts diagnose and have the confidence to provide a prognosis?

Arriving at a Diagnosis.

The importance of clinical prediction.

A true clinician is someone who combines the best of science, with the best of his or her experience to generate accurate clinical predictions. The word ‘prediction’ is one that we will keep coming back to because it is the basis of what Chiropractors, Osteopaths and Physiotherapists must do, and the basis of all intelligence.

In his book ‘On Intelligence’ Jeff Hawkins details exactly how we use prediction in all aspects of our life – it’s what makes us human and it’s what makes us intelligent. But most of us never realise the extent to which prediction is what we spend our time doing.

Your neocortex will constantly make predictions, most of which you are unaware of – and it does this on the basis of your prior experience. It is your cortex that allows an experienced Chiropractor, Physiotherapist or Osteopath to detect an odd texture in a patient’s muscles, a change in their gait or an unusual vertebral motion pattern. In fact, “What we perceive is a combination of what we sense and of our brains’ memory-derived predictions”. Your brain fills in the gaps in all of our sensory experiences (the visual blind spot is just one example) and it underpins clinical art.

In his book “Blink”, Malcolm Gladwell discusses ‘thin slicing’ or rapid cognition and shows how we draw conclusions based upon narrow slices of experience. However, your cortex can ‘weight’ all data according to perceived importance and use this to make accurate predictions very quickly.

Expert Clinicians

The first impressions of expert Chiropractors, Osteopaths and Physiotherapists should be unambiguous. With expertise our abilities become more esoteric and complex and we can think about our observations using a very specific and detailed vocabulary. As knowledge of spinal disorders becomes more profound the language used for describing and thinking about these conditions, and the management of them, becomes more graduated.

We can't treat what we can't diagnose

So should you have a diagnosis if you have back pain or neck pain?

It’s all about Clinical Clarity……….

Of course a diagnosis and a prognosis should be communicated to you by your Chiropractor, Osteopath or Physiotherapist, it’s vital to the outcome of your complaint.  The term ‘clinical clarity’ sums up nicely what separates a good clinician from a poor one.

Having clarity as a clinician involves for example knowing what type of tests are valid and which have little meaning, what structures are most likely to be involved given the patients age, gender and history and the likely outcome of various treatment types that can be offered to each particular case. Crucially. it helps us to select the best route for our patients as oppose to a one size fits all mentality, which seems still so popular.  It’s really about being a true professional.

As a Registered Chiropractor serving Gwynedd, Conwy and Anglesey I make it a priority to stay abreast of current research.  The aim is safe, effective, value for money healthcare that gives patients a ‘toolbox’ so that they can manage their issues and not yo-yo back and forth to the clinic or elsewhere with the ‘same old problem’.  It important we zoom in on the damaged structure, give it a name and discuss the anatomy.  After this we zoom out and describe the cause and therefore how we intend to fix the problem. Without ‘clinical clarity’ when assessing a patient, providing this thorough in-depth outline would be impossible.  This may be the reason we see so many relapses in patients with back pain and neck pain after they have sought advice and care from a practitioner who may lack clinical clarity.