Academy of Chiropractic’s
Lawyers PI Program
From the Desk of:
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
"Narrative Functional Social Loss"
This past month I evaluated a patient in a P-IME and asked the patient to describe the social component of their functional loss that had persisted since the accident 9 months ago. This was their direct answer to me during the history taking process:
"I am unable to go to movies, concerts, dancing or play cards with my friends as I did prior to the accident. Previously I walked 6-8 blocks and now I cannot do so without at least 5-6 rest periods during the walk as the pain is too great. I can no longer drive more than 30 minutes, where prior to the accident I was able to drive cross country. I am now also unable to have any sexual relations due to pain."
As soon as she related her inability to have sexual relationships, she broke down and cried. It made me realize that anything I asked afterwards, would be with her in "brain-lock" on emotional "melt-down".
As I was concluding my history with the patient, I gave her my business card and instructed her to go about her day and note anything she could no longer do as a result of the accident and email me a concise list. What I received a week later made me realize that patients cannot give a concise history of their functional losses in 1 short setting. They need to let it "marinate" in their minds and go about their life to realize what they can no longer do and then forward that to me in an email.
Here is what I received a week later:
Social: "I used to gather with my friends and family, I often played cards, board games, listened to music, and went out dancing. I often went to the movies, concerts, and plays; I used to go out to dinner or meet my friends and family for a drink or two. I used to love to go and walk all the street fairs, festivals, and especially the San Gennaro Italian feast each September. I no longer find joy in doing these things that I loved to do. I just don’t feel well and I’m in pain.
I used to love to go on long car drives to find hidden treasures in yard sales and go to the beach. I loved to sing and tell jokes, and laugh. I had a lot of hobbies which I loved to do. I liked to draw, paint, build things, take care of my home and make things. I loved to cook elaborate dinners for my family and friends from scratch, and bake items on the holidays.
I used to love to take my dog for long walks around the neighborhood and to parks; Mio is a small dog around 15 to 18 pounds. After my accident his walks have been limited to taking him back and forth in front of my home and maybe up the side street. I don’t walk him the way I used to; I just can’t do it anymore I’m in too much pain.
I used to dye my own hair. I no longer can dye my hair by myself and need my family to do it for me.
I used to climb up and down my stairs to my apartment on the second floor. I have difficulty doing this now. It’s just too painful.
If I get on the floor I can no longer get up easily and can’t use my knees it’s too painful. I have problems bending, knelling and getting up off the floor. I have a lot of pain trying to get up.
I used to do house hold chores, laundry, and grocery shopping with ease. Now I find it difficult to do them. I need help or it takes me a long time to do them. I have to use a shopping cart now when I go to the stores shopping. I just get don’t have the strength I used to have and I’m in pain.
My holidays were ruined since my car accident.
Thanksgiving was terrible; I used to do most of the cooking for Thanksgiving and enjoyed my holidays very much. This year everyone had to make a dish because I wasn’t feeling well and was in too much pain to do it.
My daughter and her husband came in for Thanksgiving to spend the holiday with us. We used to stay up and talk, play board games, and take a drive into the city and spend quality time together. This time it was terrible, I just didn’t have it in me to do anything do to being in pain.
Christmas was just another day for me of not feeling well and being in pain. I didn’t put up my Christmas tree this year do to not feeling well and being in too much pain.
New Years – I used to love to go out for New Years with our friends. This Year was terrible I wasn’t feeling well and was in pain. I found no joy bringing in the New Year.
Every year my sisters and I would make fresh homemade tomato sauce; jelly’s and jams at the end of each summer. This process would take up most of the day; its work but a lot of fun. I didn’t do it this year do to my car accident. I just no longer feel good or have the desire to do these things anymore. I feel too sick, I’m in pain, and I’m depressed and too weak to do them. I no longer find any joy by doing these things.
My friends and family told me that I remove myself from the crowd when we get together since my accident. They would find me isolated somewhere in the house and that I would no longer socialize the way I used too.
I have problems opening heavy doors as my strength isn’t in my arms just isn’t there anymore and it hurts.
I used to mediate prior to my accident. Now I find my mind racing and have difficulty relaxing.
I used to love to drive long distances on the highway, and very much enjoyed the ride.
Now I experience difficulty driving, I try to stay away from highway driving as much as possible. When I do, I drive the right lanes as much as possible.
When someone else is driving, I get very nervous, upset and fearful. And find no joy in car rides."
The lawyer, upon reviewing this wrote that is was a "Great and substantial report". He then immediately referred 3 additional cases to me.