The Price of Pain in Your Practice

What is the price of your own pain in your practice?

Consider this scenario. You have just finished a vigorous set of tennis with a friend. You notice a little discomfort in your right elbow but think nothing of it. The next day you wake up a feeling a little stiff. 

Later that day, you begin to see some patients and move around, and the stiffness seems to subside just a bit. The morning proceeds as usual.  After a little light lunch, you move on to the afternoon patients. Following a thorough examination of a geriatric patient, you notice a little twinge of pain in your right elbow. Rubbing it a bit, you finish the day. The next day, you wake up with discomfort but the pain worsens throughout the day. The pain seems to worsen while examining patients and lessens as you stop and rests.  

After several weeks of over-the-counter medications, you decide to trial some non-steroidal anti-inflammatories. You comply with the medication regimen and notice some relief but the symptoms persist and continue to exacerbate with patient care. 

After a couple more weeks, you decide to try some physical therapy. After comparing schedules with the therapist, you schedule an appointment in two weeks. In the meantime, you continue with the NSAIDs and try some ice. The pain is tolerable in the morning but worsens considerably in the afternoon. As a result, you modify your afternoon schedule and cut back on the number of patients that you see. 

Physical therapy starts two weeks later, but the only appointment available is at 10 a.m. The first visit takes approximately 90 minutes. The therapist takes your history, completes an examination of your upper body, neck and back. She initiates a treatment protocol of iontophoresis utilizing dexamethasone over your right lateral epicondyle.  This is followed by some soft tissue mobilization, stretching of your right shoulder, elbow, wrist and hand. The therapist then ices your elbow and describes a home stretching program for you to begin later in the day.  Lastly, she fits you with an “Aircast” tennis elbow splint for you to wear during the working day.  She recommends that you modify your work day by limiting the number of patients that you see; recommends no tennis for a while and no heavy work outside of the clinic.  

So, what is the price of this initially small pain in your elbow?  If we calculate your gross income to be somewhere between $300 to $500 per hour, let’s figure the price of this problem up to this point. 

During the first few weeks of the discomfort, there was no specific cost.  

As the symptoms worsened, you began to limit your patient visits, so let’s say you saw two fewer patients per day. If we take two patients per day for five days a week over two weeks, that comes to ~$300 x 2 x 5 x 2 = $6000.  Prescription for NSAIDs ~ $50.  

Once therapy starts, the appointments take about one hour and another half an hour for travel.  If we add this time to the two patients you have already not scheduled, we can roughly calculate the following:  3 1/2 hours per day, three days a week for six weeks comes to ~ $300 x 3 ½ per day x 3 days per week x 6 weeks = $18,900.  The rough total up until this point is $6000 + $175 + $18,900 = $25,075.

Now, assuming that the problem resolves during the course of those six weeks of treatment, you’ve gotten off fairly inexpensively.  If not, the meter is still running.  So the next time you start feeling a little nagging pain and discomfort, better heed the warning since benign neglect may not come without a price!

Doctor, Heal Thyself

What can you, as a clinician, do as a preventive strategy?  

Take a closer look at your work, exercise, rest, and stress factors during a typical work week.  

Are you balancing work/home stress with appropriate rest/relaxation?  Is your work out targeting areas of need for your body’s needs?  Are you resting enough to recover from the stress and strains that you are placing on your body?   Do you have any ongoing or lingering aches and pains that aren’t relieved by a good night’s sleep?  Do you perform any stretches during the day to counteract the stresses that you put on your body?

Consider all of these factors and take care of yourself as you take care of your patients who have pain. 

Timothy J. Caruso, PT, MBA is a practicing physical therapist who is nationally known as a professional speaker who has worked extensively with medical professionals since 1988 in the areas of ergonomics, injury prevention, productivity, exercise, and wellness.